Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

PRIVATE BUSINESS

NEWCASTLE UPON TYNE TOWN MOOR BILL [Lords]

Order for Second Reading read.

To be read a Second lime tomorrow.

Oral Answers to Questions — TRADE AND INDUSTRY

Manufacturing Industry

Mr. Henderson: To ask the Chancellor of the Duchy of Lancaster what has been the increase in manufacturing profits and in manufacturing investment in the latest three years for which figures are available.

The Parliamentary Under-Secretary of State for Corporate Affairs (Mr. Francis Maude): Figures for profits are available only up to 1986. Gross profits of manufacturing companies, including income from self-employment, at current prices increased by £2·2 billion in 1984, £2·3 billion in 1985 and £3 billion in 1986. Gross investment in the manufacturing sector, including leased assets, increased by £1·6 billion and £1·9 billion in 1984 and 1985. respectively, was unchanged in 1986 and is estimated to have increased by a further £0·8 billion in 1987.

Mr. Henderson: Against the background of those figures, is the Minister not alarmed when, with such a growth in company profits, our manufacturing investment is still 11 per cent. lower than in 1979? Is the Minister not perturbed by the pathetic level of research and development in this country, which is lower than that in France, Germany and Italy and less than a third of the rate of increase in Japan since 1981? Does he accept that that low level of R and D is a major contributory factor to our poor level of investment in manufacturing industry? Will the Minister set up an inquiry to examine those issues and consider the impact on investment?

Mr. Maude: I will certainly not set up an inquiry. The hon. Gentleman seems to think that profitability and investment are somehow inconsistent with each other. Of course, profitability in manufacturing in this country is not yet back to the levels that it reached in the early 1970s. If one wants people to invest in industry, one has to show a return on it. If people can make more money by investing in the building society than in manufacturing industry, they will do that. Profitability is now increasing and has been increasing for some years. However, it still has some way to go before it hits the levels of the early 1970s. [Interruption] I am asked what went wrong. The answer is the Labour Government in the late 1970s.

Mr. Dickens: Is it not a fact that manufacturing industry in the United Kingdom is now setting the pace in the Western world, unlike the time when overmanning in nationalised industries, paid for by the taxpayer, put those industries on a treadmill of failure? We have released those industries, and that is why the jobs that we are creating are real jobs, not overmanning manufactured jobs.

Mr. Maude: My hon. Friend puts his points robustly and well. The trend that I have disclosed is one of rising and increasing success for British manufacturing industry. It shows that not only profitability but investment, are increasing. It is encouraging that our investment intentions survey shows a further increase in investment this year of 16 per cent. with a further real terms increase in 1989. That is thoroughly good news.

Mr. Barry Jones: In support of my hon. Friend the Member for Newcastle upon Tyne, North (Mr. Henderson), may I ask the Minister to consider the fact that in 1986 import levels in textiles, steel, chemicals and motor cars exceeded £6 billion? Against that information, is the Minister not being complacent, and will he listen carefully to what my hon. Friend has said, because the Government have surrendered much of British manufacturing industry?

Mr. Maude: I hear what the hon. Gentleman has said. Of course, I listen carefully to what anybody says on this important subject. Exports from this country have increased pretty dramatically. Many of the goods to which the hon. Gentleman referred are imported by British industry for use in British industry. About 75 per cent. of imports are for industry, not for consumers.

Inner-city Policy

Mr. Adley: To ask the Chancellor of the Duchy of Lancaster if he will make a further statement on progress in implementing the Government's initiatives for inner-city regeneration.

The Chancellor of the Duchy of Lancaster and Minister of Trade and Industry (Mr. Kenneth Clarke): I am pleased to say that excellent progress has been made in implementing the action for cities measures announced on 7 March. My right hon. Friend the Secretary of State for the Environment is finalising the boundaries of the Lower Don Valley urban development corporation and hopes to lay an order before the House next month. He is about to appoint consultants to report on the extension of the Merseyside development corporation. My hon. Friend the Minister of State, Home Office launched the first of 20 safer cities initiatives in Wolverhampton on 7 April. My hon. Friend the Minister of State, Department of Employment is to open the first of six new inner-city small firms service offices in Sheffield on 19 April. 1 took part this morning in Newcastle in the first presentation to encourage company involvement in urban regeneration which was attended by about 200 local business leaders..

Mr. Adley: I thank my right hon. and learned Friend for that reply and welcome the progress that has been made. Nevertheless, does he agree that resources for investment in the public and private sectors inevitably are finite? Does he accept that for property developers in particular the pickings to be gained by developing in the over-developed, luscious parklands of the south are far easier than redeveloping in urban areas of the kind to which he has alluded? Will he please get together urgently


with my right hon. Friend the Secretary of State for the Environment to see whether we can add to the incentives that he has announced disincentives to develop in over-developed areas?

Mr. Clarke: I am glad to say that the total level of investment in the United Kingdom economy, particularly manufacturing investment, is continuing to rise. I do not accept that the level of investment is necessarily finite. However, I understand my hon. Friend's anxiety about the pattern of development, and I am sure that he will welcome many of the measures that I have just announced, because they make it ever more attractive to invest and develop in parts of the country that previously were in decline. Those areas need new factory and housing development for the kind of growth that we are describing.

Mr. Malcolm Bruce: Does the Minister accept that for the regions and inner cities, particularly in the north and Scotland, to be successful, they will have to be given a fair share of the corporate headquarters and jobs that go with them? What steps does he propose to take to ensure a greater balance and distribution of those jobs rather than an excessive concentration in the south-east, to which the hon. Member for Christchurch (Mr. Adley) referred and by which the right hon. Member for Henley (Mr. Heseltine) is disturbed?

Mr. Clarke: I agree with the hon. Gentleman that the difficulty is that a large proportion of companies tend to have their headquarters in London and the south. The geographical size of the United Kingdom is not so great that that problem cannot be overcome. In the end, it is for companies to decide where to locate their corporate headquarters. In that regard, Scotland has certain advantages over provincial England, and there are indeed more corporate headquarters in Scotland.

Mr. Beaumont-Dark: Does my right hon. and learned Friend accept that I do not wish to damage the scheme by praising it? I believe that what is being done in the inner cities is the result of one of the best and most robust measures that we have taken in this Parliament. Will he ensure that aid is provided to level old factories so that new industries can rise and thrive? That would be one of the most interesting and useful things that any Government could do for the midlands.

Mr. Clarke: I am grateful for my hon. Friend's support and advice. I hope that we can help those involved in the Birmingham heartland scheme to achieve what he described in that large area of derelict land in west Birmingham. Everybody with an interest in Birmingham must want to see that area developed as rapidly as possible. We hope that Sir Reginald Eyre and his colleagues will be able to make rapid progress.

Mr. Gould: What is the point of breakfasting business men at £400 a head when the reality is that in a city such as Newcastle, where the Chancellor was this morning, there will be a loss of £2·8 million in purchasing power as a consequence of the changes in the social security scheme? Is not the combined effect of the Government's changes in the Budget and the social security scheme to take money from the deprived in the inner cities and give it to the affluent, who are largely in the south-east? Does that not mean that the effect of the Government's much touted initiative is to perpetrate a cruel and wicked charade?

Mr. Clarke: I do not mind having my leg pulled about breakfasts, but this morning's presentation to the leading

business men of the city was very professional. The hon. Gentleman will find that they were impressed by what they heard. They intend to build on what has been achieved with the new Metro centre in Gateshead and the new Burton Design Works in Newcastle. The economy of the area is reviving and will revive in the inner cities. I am sure the hon. Gentleman will welcome the fact that our changes to the rating system, particularly the non-domestic rate, will ensure a reduction in commercial rates in Newcastle of 32 per cent. in the near future. That policy benefits the north, largely at the expense of the south, in a way that he should welcome.

Information Technology

Mr. Cran: To ask the Chancellor of the Duchy of Lancaster what steps his Department is taking to help improve the quality of usage of information technology in British businesses.

The Parliamentary Under-Secretary of State for Industry and Consumer Affairs (Mr. John Butcher): My Department encourages British businesses to make efficient and effective use of information technology by a variety of means, including the encouragement of best practice, support for collaborative research and development and technology transfer. It is, of course, for individual firms in their particular circumstances to decide how best to make use of IT and so derive the best possible benefit from investment in the technology.

Mr. Cran: Does my hon. Friend agree that the contribution that the better use of information technology can make to the competitiveness of British industry is much under-estimated in this country? Does he also agree that, because the Government are major users of information technology to the tune of £1·5 billion a year, they can set a good example to British industry? Therefore, will he outline to the House how he is sure that his own Department is taking the correct decisions both at the point of purchase and after the event?

Mr. Butcher: The best way of seeking our own departmental assurance is to take advice, where necessary, from experts and practitioners in the industry. I should like to reassure my hon. Friend that we do our very best to remain enlightened users of IT. The general impact of IT usage is a key-enabling technology which pervades all sectors of the economy. That is why my hon. Friend's question is so relevant. Certainly, to my knowledge, for the first time since the war Britain is now out-performing the Federal Republic of Germany in a crucial application area—the use of computer-aided design and computer-aided manufacturing equipment. We are now, in the first major investment programme since the war, outstripping the Germans to the tune of 8 per cent. market penetration. I believe that that is a very significant event.

Dr. Bray: Will the Minister nevertheless recognise that the failure to produce a follow-on programme for the Alvey programme and the substitution for it of the ESPRIT II programme within Europe has left a void in Government support, specifically for the application of new techniques for the British partners in international collaborations? Does he realise that that is losing the country a great deal of the benefit which, as he rightly said, we are fully capable of achieving from information technology if only we are properly organised, with the support of the Government?

Mr. Butcher: We achieved final agreement for ESPRIT on Monday. The hon. Gentleman is correct when he says that there was no follow-up to the Alvey. He will know that there is a programme of about £84 million over five years, partly funded by the Science and Engineering Research Council and by ourselves, which is following up a number of Alvey initiatives. He will also know that there are a number of other programmes in electronics and information technology. We now have, subject to an additional review, the Gallium Arsenide programme, which has been complicated a little by the difficulties between the two participating companies. So we are following up Alvey in the right way in collaborative and pan-European research.

Urban and Rural Areas

Mr. Nicholas Bennett: To ask the Chancellor of the Duchy of Lancaster what assessment he has made as to what lessons derived from inner-city initiatives can be applied in other distressed urban and rural areas.

Mr. Kenneth Clarke: There are three clear lessons. First, the private sector has to he involved in regeneration measures. Public money should be used to bring in private investment. Secondly, efforts to encourage business, improve the environment and motivate local people are more effective when combined. This is why we have established city action teams and task forces to pull together Government effort in inner cities. Thirdly, action has to reflect local circumstances. We have therefore developed a range of measures—from urban development corporations to compacts between schools and industry—to respond to local needs.

Mr. Bennett: Will my right hon. and learned Friend bear in mind that many of the economic and social problems of the inner cities are found on a smaller scale in many rural towns and rural areas across the United Kingdom? Will he therefore draw to the attention of local authorities in those areas some of the exciting solutions that he is finding in the inner cities?

Mr. Clarke: I know that my hon. Friend's constituency suffers from a high level of unemployment. There are many similarities between the problems in Pembrokeshire and those in the depressed towns in the north and in the inner cities in parts of the midlands and the south. Therefore, I accept my hon. Friend's argument that many of the lessons we have learnt about how to stimulate new investment, new business and new employment could, with advantage, be applied to places such as Pembrokeshire.

Mr. Vaz: Does the right hon. and learned Gentleman agree that one of the lessons to be drawn from the Leicester experience is the Government's inability to co-operate with and consult the local authority? That is why the inner city initiative in Leicester has been such a disaster.

Mr. Clarke: I think that the inner city initiative in Leicester has been a considerable success, and that it is getting better, because we appear to be achieving a slightly higher level of co-operation with the local authority. It has something to do with the so-called new realism which is said to have been affecting the Labour party since the last general election. In so far as there has been unnecessary political dispute in Leicester, plainly I must assert and remind the House that it was wholly caused by the

immediate hostility of Leicester city council the moment that we announced our initiative and before the Government agents had arrived.

Mr. William Powell: Does my right hon. and learned Friend accept that the inner city areas that he is working so hard and with a degree of success to try to bring round have a great deal to learn from other areas in the country that have also been through depressed times? Will he take on board what has happened in my constituency and ensure that the lessons of Corby are applied in all areas that face high unemployment?

Mr. Clarke: The amount of new investment and the collapse in the level of unemployment in Corby are quite spectacular. They are almost matched by the new investment in Scunthorpe and by the new investment in jobs in Consett, both towns having been affected by changes in the steel industry in the past. I agree with my hon. Friend that the success in Corby shows what can be achieved by towns elsewhere that face a severe economic crisis. We shall apply the lessons of Corby throughout the country.

Mr. Campbell-Savours: What lessons has the Minister learnt from Scottish and Newcastle's approach to inner city initiatives, which was to take jobs out of a profitable brewery in Workington—a brewery that received Government grants over the years—and put them into Newcastle? Does he not understand that that constitutes the rape of Workington? It is a criminal act in a moral sense. That company has no right at all to act as a job thief and take jobs away from a profitable brewery in try constituency. Will he now intervene, whereas previously he refused to do so?

Mr. Clarke: The hon. Gentleman must take up with the management his grievances about the decisions of Scottish and Newcastle Breweries. In my experience of the inner city policy, Scottish and Newcastle Breweries has been a very responsible company. It has worked closely with the Government at its Moss Side brewery in the middle of Manchester, where it received a large urban development grant and recruited and trained a large number of unemployed people from the deprived area around the brewery. It has been equally responsible in the north-east of England. The hon. Gentleman knows perfectly well that as a Minister I have no responsibility for the dispute in Workington to which he referred.

Mr. Hind: Will my right hon. and learned Friend bear in mind that Skelmersdale has very similar problems to Pembroke? In the last 12 months the level of unemployment in the new town has been reduced by nearly 1,500 and major steps have been taken to build new factories in the town. When the task forces in the inner city areas have done their job, will he bear in mind that they could do a great deal of good in places such as Skelmersdale and Pembroke and in other rural and urban areas that are not included in the inner city initiatives?

Mr. Clarke: I share my hon. Friend's pleasure at the fall in unemployment in Skelmersdale and in the north-west generally. I agree that we have to look at the problems faced by all communities such as his in the north-west. We always envisaged that the task forces would be temporary in the cities, where they were established, and that they would aim to work themselves out of a job so that they


could move to other parts of the country when they had carried out the necessary pump-priming in the inner city districts.

Mr. Caborn: When the Chancellor of the Duchy of Lancaster considers expanding these schemes, will he take into account the role of local authorities? Many people are worried by independent reports about the urban development corporations and the task forces showing that, because of Government dogma, the best results are not being achieved. A major report, funded by the Government and local authorities, showed clearly that in the Sheffield scheme it would have been far better to have a partnership than to impose an urban development corporation. Some now say that the UDC could impede progress. Will the Chancellor and his Department have a word with the Secretary of State for the Environment to make sure that there is no imposition and that instead a genuine partnership is developed that involves the local authorities?

Mr. Clarke: We achieve excellent relationships with local authorities of all political complexions in some parts of the country. I share the underlying assumption of the hon. Gentleman's question that it is desirable for the Government, local authorities and the private sector to work together.
Although there is a difference in the conclusions arrived at for the redevelopment of the Don Valley, I do not believe there is any difference between the aims of the Government, the hon. Gentleman and the local authority. I believe that, in time, it will be realised that the Don Valley urban development corporation is of considerable benefit to Sheffield and south Yorkshire, and that it will prove of considerable advantage in redeveloping the land more quickly than the alternative proposals would have done.

Exchange Rates

Mr. Knox: To ask the Chancellor of the Duchy of Lancaster what representations he has received about exchange rate stability from manufacturing industry during the past 12 months.

Mr. Kenneth Clarke: My Department has received representations from a number of companies and trade organisations on the subject of exchange rates.

Mr. Knox: Does my right hon. and learned Friend agree that manufacturing industry greatly prefers stable to floating exchange rates and would like Britain to join the exchange rate mechanism of the European monetary system? Is he pressing that view on his colleagues in the Government?

Mr. Clarke: We all wish to see a certain stability in exchange rates, because that is to the advantage of all international trade. However, given the present state of the international exchange markets, it is not possible to achieve complete stability. I have always found the EMS and the idea of joining it attractive. As my hon. Friend knows, the Government will decide whether to join it when the time is right.

Mr. Hayes: Is the Chancellor of the Duchy of Lancaster aware that not many days ago, just before the Easter recess, we had a meeting here with the representatives of the hosiery and knitwear trade and the unions working in it? The right hon. and learned Gentleman, of course, was

not present at the meeting, so I am telling him about it now. During those discussions the representatives mentioned not only the unfairness of competition but the financial instability in the exchange rate. When will the Government do something about the problem? Industry is crying out for stability to help it on its way to success. Will the Minister get off his backside and do something about it?

Mr. Clarke: I am sorry that my duties as a Minister sometimes prevent me from pursuing my interests as a constituency Member and attending meetings with representatives of the hosiery and knitwear trade. I am delighted that the hon. Gentleman was there looking after the interests of my county and of those who work in the industry.
Of course, we all desire reasonable stability in exchange rates. However, hon. Members must consider the state of the world exchange markets. No currency can be guaranteed stable exchange rates. Exchange rates have, in fact, been rather advantageous for the bulk of British industry over the past 18 months or two years, but some movements are inevitable, given the present state of international markets.

Mr. Grylls: Does my right hon. Friend agree that, while it is obvious that industry prefers stable exchange rates, another perhaps even more important factor is the control of inflation? When the CBI next complains about the exchange rate going up in Britain, will he perhaps remind it that in Japan the yen has appreciated by 40 per cent., and that that country is still able to beat us in many of our export markets?

Mr. Clarke: I agree with my hon. Friend. Germany and Japan do not seem to have suffered noticeably from having strong currencies over the past few years. My hon. Friend is also right that, when the level of interests rates is being set, a number of factors must be taken into account. One is the effect of changes on the exchange rate; another is the effect on internal demand, monetary policy and the inflation rate.

Rover plc

Mr. Strang: To ask the Chancellor of the Duchy of Lancaster when he last met the chairman of Rover plc; what subjects were discussed; and if he will make a statement.

Mr. Kenneth Clarke: I made a statement on 29 March on the subject of Rover Group privatisation, and I have nothing further to add.

Mr. Strang: Does the Minister accept that most people will judge the Government's sale of Rover by the extent to which British Aerospace increases volume car production and maintains—if not accelerates—the pace of design and engineering projects, including the crucial new Metro? In view of the reports in yesterday's and today's Financial Times, will the Minister make it clear that there is no question of the Government's allowing the EEC to reduce the amount of public money going into the new combined company, as that would be bound to have an adverse affect on investment and jobs?

Mr. Clarke: There are European Community rules on such matters, and sensible discussions are now taking place between us and the Commission, which will reach their outcome in due course. The agreement that we have


reached is subject to the Commission's approval, and to that of British Aerospace shareholders. We shall have to await the outcome of the discussions taking place now in Brussels on the first point.

Mr. Budgen: Since, no doubt, the chairman of Rover demanded stable exchange rates, and since the Chancellor of the Exchequer has promised stable exchange rates to manufacturing industry, will my right hon. and learned Friend be good enough to guarantee to the rest of the community eternal youth?

Mr. Clarke: I have no recollection of having promised stable exchange rates to anybody. I rather regret that it is impossible for any Chancellor of the Exchequer to achieve complete stability in exchange rates in present circumstances. We would be more interested in discussing with the Rover Group the terms upon which we negotiated the proposed sale to British Aerospace. I think that they are reasonable, that £800 million is a fair reflection of the debts that would be accumulated by Rover Group at the time of completion of the sale, and that the £150 million that BAe proposes to pay is a fair price for the Government's share.

Mr. Hoyle: When the Minister next meets the chairman of Rover plc, will he ask him when he intends to meet the trade unions? Does he agree that there was no consultation with the trade unions prior to the announcement of the bid by BAe—[Interruption.] Never mind the yahoos behind the Minister. The trade unions do matter to the people who work at Rover. We occasionally hear from the Tories that they matter. One of the Minister's colleagues behind him is nodding assent. Does the Minister agree that they matter just as much as shareholders? Will he ask the chairman to meet the trade unions to explain about the bid from BAe and where Rover fits into the picture?

Mr. Clarke: As my hon. Friend the Member for Solihull (Mr. Taylor) was provoked into remarking a moment ago, not surprisingly consultation with the trade unions was no doubt complicated by the rather foolish strike that was taking place at Solihull at the time that the negotiations were under way. However, I am sure that if the hon. Gentleman puts his point to the chairman of the Rover Group he will be reassured about reasonable relationships with the trade unions. I suspect that large numbers of trade unionists inside the Rover Group rather welcome the proposed deal with BAe and think that it offers them a good stable future in the private sector.

Mr. Oppenheim: When will my right hon. and learned Friend scrap the so-called gentleman's agreement by which we put up non-tariff barriers against Japanese cars? Is it not true that those non-tariff barriers benefit Japanese manufacturers by giving them a cosy high-price market in which to sell, compound the inefficiency of the British industry and cost consumers dear?

Mr. Clarke: We keep such agreements under review inside the Government. I have considerable sympathy with my hon. Friend's point of view that, on closer analysis, such deals often turn out to be of considerable advantage to Japanese importers by guaranteeing higher prices for a lower volume of sales than they would otherwise be able to have.

Mr. Andrew Smith: Will the Chancellor clarify the precise allocation of the £800 million cash injection? Can he confirm reports that, depending on the definition of debts in the Rover Group's balance sheet, a surplus of between £43 million and £240 million will accrue to BAe?

What guarantees can he give that that money will be invested in jobs and new vehicles, and not used to inflate BAe's share price?

Mr. Clarke: The figure of £800 million was a reasonable estimate of the level of debt likely to be faced by the company at the time of completion of sale. I think that the hon. Gentleman has, understandably, been disturbed by some of the interpretations that have been put upon the Rover Group's annual accounts which were published recently. The figure of debt shown there was the figure at 31 December 1987, not at the expected date of completion of sale. The figure in the published accounts leaves out the provision that has already had to be made for restructuring costs that will be incurred following the changes made in Leyland Trucks. When one takes into account further additional losses likely to be made this year, one comes to the £800 million, which was the Government's best judgment.

Mr. Wells: Will my right hon. and learned Friend quickly resume the proper position of a Minister in the Department of Trade and Industry in relation to the Rover Group and advocate to the chairman of the Rover Group that he takes quick action to invest in Land Rover so that new models can be produced, so that spare parts can be provided to those who have bought from Rover in the past and so that service and marketing arrangements, which have been woefully inadequate, can be improved dramatically within the next nine months in order to make the industry one of the great growth industries in Britain?

Mr. Clarke: I am sure that the proper role of a Minister of Trade and Industry is to leave such matters to the commercial judgment of the owners of the company, but I am sure that the chairman of the company would acknowledge the force of some of my hon. Friend's criticisms. Land Rover is obviously a very attractive part of the business. It should have a very strong future and I am sure that the present management, under new or present ownership, will take steps to ensure that its performance is everything that we would desire.

Mr. Blair: Returning to what the right hon. and learned Gentleman was saying a moment ago, is it not the case that, on any basis, the £800 million cash injection is a generous estimate of indebtedness and that it is certain to leave some surplus over and above the indebtedness of the Rover Group? In those circumstances, is not the failure to achieve any guarantees on investment, model development or jobs all the more extraordinary and lamentable? What was the right hon. and learned Gentleman's Department doing over the past few weeks? Was it conducting a genuine commercial negotiation on behalf of the taxpayer, or was it getting rid of Rover at any price?

Mr. Clarke: I do not agree with the hon. Gentleman's assertion. In more detailed discussions with the European Commission, I trust that we shall be able to satisfy it that we are making reasonable provision.
I am not sure what the point of the hon. Gentleman's attacks is. His comments slightly contradict those made a moment ago by his hon. Friend the Member for Oxford, East (Mr. Smith), who feared that there might be some reduction in the amount of public money going into the company. We are interested, not just in injecting public money into the company, but in making a reasonable and


proper deal. The deal is based on what we think is a good estimate of the level of bank indebtedness of this company at the time of the likely completion of the sale.

Single European Market

Mr. Sackville: To ask the Chancellor of the Duchy of Lancaster what representations he has received about his campaign to publicise the approach of a European single market.

Mr. Maude: We are continuing to receive a large number of representations, all of which warmly support our campaign to alert British business to the challenge of completing the single market. The major phase of our campaign starts with a national conference at Lancaster House next Monday, 18 April.

Mr. Sackville: Does my hon. Friend agree that the concept of the single market will suffer if monopolistic concerns in Europe, such as airlines or steel producers, continue to operate cartels, unofficial or official, to the great detriment of users and, indeed, to employment?

Mr. Maude: One of the objects of the completion of the single market is to make sure that competition operates within the market to the benefit of consumers.

Mr. Beith: Would it not be to the advantage of British business if we had joined the exchange rate mechanism of the European monetary system by the time we join the single market? In that case, why is the Minister of Trade and Industry saying that the time is not yet right to join the EMS? Will he still be saying that in 1992, if he is still there?

Mr. Maude: It is not for people in my position to predict the future. My right hon. and learned Friend makes his point about when he thinks is the right time to join the ERM and no doubt those making the decision will hear what he says.

Sir Ian Lloyd: Have the Government made any attempt yet to estimate what are likely to be the massive savings that should be made in British Customs administration from 1992 onwards?

Mr. Maude: There should be significant administrative savings. There are also estimated to be significant economic advantages to the whole of the Community. A report by the European Commission indicates that there should be increases to the Community's GNP of about £140 billion. Obviously, that has a major advantage for us. To those who say that the advantages will go one way, I say that that is a sad reflection on the competitiveness of British business. I believe that British business is now well placed to benefit from the opportunities that the single market will offer.

Mr. Grocott: Does the Minister remember all the public relations effort at the time of our original entry into the Common Market setting out the tremendous advantages to British industry? Will he check the figures and show the continually increasing deficit in manufacturing industry between Britain and other members of the European Community? Why the hell should we believe him this time when we know that the previous time—

Hon. Members: Withdraw.

Mr. Speaker: Order. I thought that I heard a somewhat unparliamentary word—why on earth would be more appropriate.

Mr. Maude: I dimly remember in the recesses of my memory what was said about the Common Market in the early 1970s, although I was a very young man at the time. To those who say that British business would not gain from the single market, I say that they are quite simply wrong. The United Kingdom is already open for trade to a greater extent than the rest of the Community. It must, therefore, be in our interests to open up the rest of Europe for British business.

Mr. Dykes: How on earth or how in hell can we have—

Mr. Speaker: Order. Let us have it on earth.

Mr. Dykes: How on earth can we have a single European market without harmonising indirect taxes?

Mr. Maude: I point out to my hon. Friend that the United States of America has had a very satisfactory single market for 200 years with some 50 different rates of sales tax in different states—not only different rates of sales tax, but quite often different systems of sales tax as well.

Mr. Gould: What will be the Government's response to the European Commission's insistence that the provisions in the case of Rolls-Royce and British Aerospace which limit foreign shareholdings to 15 per cent. should now be abandoned? Does the Government's enthusiasm for the internal market mean that they are ready to give up that essential protection for strategic British interests?

Mr. Maude: We shall continue to argue the British interest as strongly as we have in the past.

Mr. Curry: Will my hon. Friend also direct his information campaign to potential investors? Does he realise the importance that overseas companies attach to being inside the market by the time that it is completed? Is he aware of the studies that suggest that by the early part of the next decade a quarter of a million manufacturing jobs in Britain will be taken up by Japanese companies, an important proportion of which will be Wales? Is he aware that that is partly a consequence of the anxiety of those companies to be inside Europe before the internal market is completed?

Mr. Maude: My hon. Friend has made a very good point. We are already an extremely attractive environment for foreign investors. That is very much to the benefit of the United Kingdom. It has created many jobs especially, if I may say so, in manufacturing industry. I am sure that the consideration to which my hon. Friend has drawn attention is material.

Electronics Industry

Mr. Pike: To ask the Chancellor of the Duchy of Lancaster what was the output of the electronics industry at the latest date for which figures are available; and what was the comparable figure in 1979.

Mr. Butcher: The index of production for the electronics and information technology industries was 170 in 1987 based on 1980 being equal to 100. This compares with 97 in 1979.

Mr. Pike: As imports of electrical goods have more than trebled since 1979, is there not a case for retaining the voluntary restraint agreements with regard to imports of electrical goods from the far east? Will not those imports


pose a serious threat to our television tube and set manufacturers, as there is a surplus of production in Japan and a growing surplus of capacity in South Korea?

Mr. Butcher: No. The increase in voluntary restraint agreements would cause immediate and long-term damage to the British economy. I want to stress to the hon. Gentleman that, if we consider the OECD group of countries as a whole, only Japan is improving its export-import ratio. Virtually all the others are falling. The export-import ratio in the United Kingdom fell by 17 per cent. It was also 17 per cent. in Germany. In France it was 21 per cent. and in the United States of America it was 40 per cent. There is a healthy increase in our electronic engineering output. If current trends continue, we can start to attack import penetration.

Mr. Jack: My hon. Friend will be aware of the growing use of electronic systems in companies such as British Aerospace in my constituency. Will he do all he can to communicate to his Government colleagues the need for the availability of trained manpower to exploit fully that important growth in our industrial world?

Mr. Butcher: I chaired a skills shortage committee three years ago which was targeted on improving the level and supply of skills in those disciplines which my hon. Friend is anxious to see enhanced—electronic engineering and manufacturing systems engineering. Within the trade figures for the electronics sector, aerospace is excluded yet we export a lot of electronics within aerospace, whereas there is a huge Japanese surplus in consumer electronics. The situation in information technology as a whole is not as bad as the overall figures would appear to show.

Single European Market

Dr. Thomas: To ask the Chancellor of the Duchy of Lancaster what studies have been made by his Department of the impact of the realisation of the Economic Community internal market in 1992 on the regions and nations within the United Kingdom; and if he will make a statement.

Mr. Maude: The completion of the single market means greater freedom of trade, and many studies from various sources have shown that this will bring benefits to all nations and regions within the European Community. We have commissioned few formal studies, but economic analysis is carried out within the Department of Trade and Industry in the course of providing advice to Ministers.

Dr. Thomas: Will the Minister accept that the benefits, or disbenefits, of the single market depend very much on the distribution of those benefits among the multinational companies, the work forces and, in particular, the regions that will benefit? Does he agree that as part of the integration of the market there is need also for a parallel integration and enhancement of social policy, of social fund spending, and of regional investment?

Mr. Maude: The hon. Gentleman will know that it has recently been agreed in the Community that the structural fund should be doubled in the next few years, so the contribution made by structural funds to the regions of the United Kingdom will be increased. I hope the hon. Gentleman accepts that that will be beneficial. I take the point that he broadly makes, that success for regions depends on the distribution of benefits, but there is no

reason why successful businesses in the regions of the United Kingdom should not benefit if they are competitive.

Mr. Gow: How resolute will my hon. Friend be before and after 1992 in asserting the proposition that the rates and scope of value added tax and other indirect taxes imposed upon the British people should be matters for the Chancellor of the Exchequer and this House and not for the Commission?

Mr. Maude: It will not fall to me to be resolute or irresolute about it, but I can assure my hon. Friend that the Chancellor of the Exchequer and the Prime Minister intend to be very resolute.

Mr. McCartney: One of the possible effects of the operation of the internal market may he to allow into this country combustion-modified foam and other foams which—after February next year—it will be illegal to sell here. Will the Minister refute the statement issued by Conservative Members of the European Parliament that the British Government should go back on that commitment and accept lower safety standards, such as are currently allowed in Belgium, West Germany and Italy, so that when the internal market comes into operation such dangerous types of foam can re-emerge and be sold on the British market? Is it not a disgrace that this major step forward should be undermined by Conservative Members of the European Parliament?

Mr. Maude: I can assure the hon. Gentleman that we have no intention of going back on the decision which I announced in January about foam in furniture. Those regulations will apply to any furniture supplied in this country, no matter what its origin.

Mr. Ian Taylor: Has my hon. Friend noted that the Cecchini report, to which he referred indirectly in an earlier answer, suggests that the single market will add 5 per cent. to the gross domestic product of the European Community as a whole? Will he confirm that it is up to industry in the regions and in this country generally to take full advantage of the opportunities that he is drawing to their attention in the 1992 publicity campaign, and also that it is essential that the regions press for the continuation of this Government's economic policies, which make our country more attractive in the European Community than others?

Mr. Maude: The report to which my hon. Friend refers has not yet been published, but the Commission has previewed some of its contents, which show that there are major economic benefits to flow from the completion of the single market. My hon. Friend is absolutely right when he says that the success of this Government's economic policies has not only made the United Kingdom very attractive to investment but has made British business fitter, more supple, more resilient and better equipped to take advantage of the opportunities of 1992 than under any previous regime.

Mr. Dalyell: Are Ministers at all queasy about approaching the single market when our research and science funding is much less satisfactory than in competitor countries? How about inviting Sir George Porter to breakfast and answering his television lecture on Sunday night? Would the Minister be ready to do that?

Mr. Maude: Sir George Porter is very welcome to come and have breakfast whenever he wishes, and we would have an interesting conversation.
In response to the first part of the question, no, we are neither anxious nor queasy.

Polystyrene

Mr. Stern: To ask the Chancellor of the Duchy of Lancaster if he has any plans to further restrict the use of polystyrene, in the light of the latest research on fire risks; and if he will make a statement.

Mr. Butcher: When polystyrene is used to provide a filling for an article of upholstered furniture it will be required, following proposals in the currently circulated draft regulations, to conform to the requirement for "other fillings", that is, other than polyurethane foam and latex rubber foam.

Mr. Stern: In view of the dangers perceived by fire officers and the general public in the domestic use of polystyrene foam, especially in ceiling tiles, does my hon. Friend have any plans to extend the furniture studies, which have already been so welcome, into the use of that foam, with a view to safeguarding the public against that fire risk?

Mr. Butcher: As my hon. Friend will know, our attention is focused on polyurethane foam, given its toxic and occasionally tragically lethal capabilities. Our research on polystyrene is admittedly now some years old but comes from the Fire Research Station, and shows that when used as specified, polystyrene tiles are not a significant addition to the fire hazard. However, in the light of the correspondence that my hon. Friend has sent me and his comments today, I shall ask the Fire Research Station to update that earlier report to ascertain whether it can identify a significant hazard.

Mrs. Dunwoody: Is the Minister aware that many people are now very worried about the fire hazards of artificial materials? Will he run a campaign to make it clear to people whether their existing furniture and ceiling tiles are dangerous, for otherwise many people will continue to be utterly confused? They need such information to be able to take sensible and informed decisions.

Mr. Butcher: I can understand the hon. Lady's concern. She will know that we shall be introducing the most rigorous fire prevention regime in the world for foam-filled furniture and furniture covers. We do not have recent information to show that polystyrene presents the sort of danger that the hon. Lady currently suspects. However, as I said earlier, to have complete peace of mind I shall ask the Fire Research Station to take another look at it.

British Steel

Mr. Grylls: To ask the Chancellor of the Duchy of Lancaster what representations he has received from private sector steel companies about the proposed role of British Steel in the private sector.

The Parliamentary Under-Secretary of State for Industry (Mr. Robert Atkins): I have received no formal representations from private sector steel companies on this subject.

Mr. Grylls: Does my hon. Friend accept that if we are seeking to establish a fair market in Europe it is important that the steel quotas should be abolished so that the efficient firms in our country can prosper?

Mr. Atkins: My hon. Friend will be well aware that my right hon. and learned Friend the Chancellor of the Duchy of Lancaster is at the forefront of a campaign to do just what my hon. Friend wants.

Mr. Crowther: Bearing in mind that the present level of profitability in BSC is only just a little above what Sir Robert Scholey says he needs every year for reinvestment, is it not obvious that the Government are rushing BSC into the private sector because Ministers want to get it off their hands before it is hit by the full impact of electricity price increases, which will reduce its competitiveness, and before it is thrown into a cut-throat price war in Europe following the abolition of quotas? What assurance can the Minister give the House that a privatised BSC would be able to prosper or even to survive in those circumstances, and without the kind of backing that its competitors in Europe will certainly get from their Governments?

Mr. Atkins: We are entirely happy with the achievements of the chairman of British Steel, together with the work force. We are more than satisfied that the sort of effort that is being put into making the company successful now will help it to be just as successful when it returns to the private sector, where it belongs.

Mr. Oppenheim: Is it not true that steel quotas cost jobs in the steel-consuming industries by pushing up the price of steel? Will my hon. Friend put up a firm fight against the European steel producers who are pushing for an extension of those pernicious quotas, which do our economy nothing but harm?

Mr. Atkins: Yes, Sir.

Mr. Hardy: Is it not the case that in the Federal Republic legal action is being prepared, not only against Finsider, the Italian steel company, but against the British Steel Corporation? In view of that development, is it not reasonable to suggest that a proper response should be offered and any difficulties surmounted before any further progress is made along the course of privatisation?

Mr. Atkins: I understand that the West German Iron and Steel Federation has complained to the European Commission about the Commission's approval of payments made to BSC between 1975 and 1985, which were approved by the Commission under the rules operating at that time. It is not a new complaint. Similar complaints have been made by German industry in the past and they have been rejected by the European Commission. It is, of course, for the Commission to consider the present complaint. We reject any allegations that illegal state subsidies have been paid to BSC in the past, since all those payments were approved by the Commission. BSC is now profitable and self-supporting.

Mr. Morley: We have been talking about the single market in the EEC. If BSC is returned to the private sector, will it not have to compete in unfair conditions in the sense that it has to face energy costs which are being used as a form of indirect taxation and to pad out the proposed privatisation, and rate support grant cuts which again are being used as a form of indirect taxation? That means that


BSC will not he able to compete on equal terms. Or do the Government not care, once it is out of their control and responsibility?

Mr. Atkins: These are matters for the British Steel Corporation. As I said earlier, we are satisfied with the judgment of the chairman, the board and the work force of British Steel about being able to cope, because they want to be returned to the private sector.

Advice and Debt Counselling Services

Mr. Michael: To ask the Chancellor of the Duchy of Lancaster what discussions he has had with credit companies, banks and other financial institutions about his suggestion that they should fund independent agencies to provide free money advice and debt counselling services; what discussions he has had with organisations currently involved in the provision of advice services; and what responses he has received in each case.

Mr. Maude: I have had a number of meetings with representatives of the financial sector at which I have stressed the importance of money advice and encouraged the principle of companies and associations providing financial and other support to voluntary bodies concerned with the provision of money advice. It is for these bodies to seek support from industry for specific projects.
As I said in my reply to the hon. Member on 9 March, a number of money advice support projects have already been funded by the private sector through the National Association of Citizens Advice Bureaux, and others. I hope that this trend will continue.

Mr. Michael: Does the Minister not accept that that is a wholly inadequate answer and a complete abrogation of responsibility on his part? Does he not accept that, in view of the insultingly light answer given by the Secretary of State for Social Services, who is doing so much to increase debt problems, the Government as a whole have a responsibility to take positive action? Will he take positive action to persuade those to whom he is passing the buck that they should make a significant contribution if he continues to refuse to do so?

Mr. Maude: For one thing, we already provide substantial support to the advice services. We support them to the extent of some £9 million for central services. That was increased specifically for the purpose of providing information on the new social security system. I

already do a certain amount to persuade the financial services industry to provide support in the way that the hon. Gentleman suggests. I seem to have been persuasive, because a number of projects are going ahead.

Mr. Boswell: I thank my hon. Friend for his reply. While I do not agree fully with the argument of the hon. Member for Cardiff, South and Penarth (Mr. Michael), may I ask my hon. Friend to accept that the problem of debt is growing, for reasons which are multiple and complex, and that it is an important part of the responsibility of the private sector, which is generally offering the debt, to take action in the public interest? Will he reinforce with the private sector the importance of its part, in conjunction with him and others, in dealing with the problem?

Mr. Maude: It seems to me that it is not only part of the responsibility of the private sector, but is very much in its commercial interest to provide support for money advice services. The more people who are helped to resolve their debt problems, the more money will be recovered by those who lent money in the first place. Advice services to those bodies concerned with giving money advice might find it useful to approach, for example, the utilities which supply fuel on credit, which forms part of most people's debt problems.

Mr. Skinner: Why should there be different laws for people and for banks in relation to debt? Why should banks be able to to go to the Inland Revenue and say. "We have run into trouble with debts abroad; can you give us £1 billion to spread among the top four banks?", while ordinary people who have got up to the neck in debt because of Government policy are told that they will have to find another loan? It is no wonder that the residual income which goes in debt payments for every family in Britain has risen to over 80 per cent., whereas it was just over 40 per cent. in 1979. We have a Prime Minister who preaches thrift and no borrowing, yet the country is up to the neck in debt.

Mr. Maude: For the vast majority of individuals, the increase in credit that has undoubtedly taken place has been wholly beneficial. It has enabled them to even out peaks and troughs in their household budgeting. I repeat that it has been wholly beneficial. But for a small minority of people, debt problems arise. It is for such purposes that money advice services exist.

Inner London Education Authority (Poll)

Mr. Jeremy Corbyn: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
the result of the London parents' poll and the future of the Inner London education authority.
As hon. Members will no doubt have heard, the parents of children in inner London schools undertook a poll to find out their opinions on the future of the Inner London education authority. Of a total of 265,596 ballot papers that were issued to parents—one on behalf of each child in an ILEA school—145,259 were returned. The parents were asked to state whether they were in favour of or against the transfer of education functions to inner London local authorities. Voting took place, and 8,004 voted in favour of a transfer, and 137,021 voted against a transfer. In other words, 94·3 per cent. of the votes were against the transfer, which represents an absolute majority of all those who were eligible to vote in the election, and 51·6 per cent. of parents of London children have said no to a transfer.
The matter is urgent and specific simply because, halfway through the Committee stage of the Education Reform Bill, in the most cavalier fashion possible, the Government introduced an amendment to destroy the Inner London education authority and impose massive cuts on education spending throughout inner London. The Government even refused to meet parent delegations, refused to support the idea of the parents' poll, and did nothing but smear parents' efforts to conduct the poll. I remind Conservative Members that the Electoral Reform Society counted the votes. There can be no dubiety about that. The Government forced the issue through the House in a most disgraceful manner. We must debate the matter because the parents of London children have said clearly, emphatically and simply that they wish to retain a unitary education system for inner London.
For the sake of the reputation of the House and of democracy in this country, it is now incumbent on the House to agree that it is necessary once more urgently to debate the future of the Inner London education authority so that the views of parents, who are anxious to protect their children's education, further and adult education and the principles of a free education service, can be properly debated and reflected upon in the House.
I hope, Mr. Speaker, that you will be prepared to recognise the urgency and importance of the matter and will grant leave for a debate.

Mr. Speaker: The hon. Member has asked leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,
the result of the London parents' poll and the future of the Inner London education authority.
I listened with careful attention to what the hon. Member said. I regret that I do not consider the matter that he has raised as being appropriate for discussion under Standing Order No. 20. I have no doubt that the hon. Gentleman and the House will have further opportunities to debate the matter.

Mr. Brian Sedgemore: On a point of order, Mr. Speaker. Of course we entirely accept your decision, but as we have just heard the most powerful expression of parent power that has ever taken place in any Western democracy, is it not appropriate for the Under-Secretary of State for Education and Science either to make a statement now or to inform the House that a statement will be forthcoming?

Mr. Speaker: I have had no notification of a statement today.

Mr. Frank Dobson: Further to the point of order, Mr. Speaker. The proposal to abolish the Inner London education authority was never put to the electorate. The Government have no mandate for it. They did not include the proposal in the Education Reform Bill when it was first put to the House; it was introduced only after the Bill had been published. As you, Sir, may recall, we asked that, in the circumstances, the Government at least postpone the debate on the part of the Bill that related to ILEA until the poll had been properly conducted by the Electoral Reform Society so that the parents of London might have an opportunity to express their view. In line with the Government's—

Mr. Speaker: Order. This seems to me to be an argument of Government policy and not a question of order. Will the hon. Gentleman come to his point of order?

Mr. Dobson: As you, Sir, frequently and rightly say, it is your duty as the Speaker to sustain the democratic reputation of the House. No Member of this House, elected in a general election as recently as June 1987, has a mandate to abolish the Inner London education authority. Hon. Members who support that proposition said that they wished—

Mr. Speaker: Order. We have a Standing Order No. 20 debate this afternoon. The hon. Gentleman must raise a point of order that I can answer. It is not right that he should seek an opportunity to make a political point on a Bill which has already received its Third Reading in the House.

Mr. Dobson: I acknowledge that the Bill has received its Third Reading in this House: but it never received a first reading at the general election. We want to know whether you, Mr. Speaker, have received any representations from the Government seeking to make a statement, to reconsider the part of the Bill dealing with ILEA or in any way to reflect the democratic decision of the parents of inner London.

Mr. Speaker: I repeat that I have received no such application. As I said to the hon. Member for Islington, North (Mr. Corbyn) a few moments ago, I have no doubt that this will be the subject of debate when the Bill returns from another place.

BILL PRESENTED

FOREIGN NUCLEAR, CHEMICAL AND BIOLOGICAL BASES (PROHIBITION)

Mr. Tony Benn, supported by Mr. Eric S. Heifer, Mr. Jeremy Corbyn, Ms. Dawn Primarolo, Mr. Dennis Skinner, Mr. Bob Clay, Mr. John Hughes, Mr. Harry Cohen, Mr. Bill Michie, Ms. Diane Abbott, Mr. Pat Wall and Mr. Dave Nellist, presented a Bill to prohibit by law the siting of nuclear, chemical and biological weapons under the ownership or control or joint control of foreign countries within the United Kingdom, the British Isles or British territorial waters or British airspace or bases; and for purposes connected therewith: And the same was read the First time; and ordered to be read a Second time tomorrow and to he printed. [Bill 138.]

STATUTORY INSTRUMENTS, &c.

Ordered,
That the draft Meat and Livestock Commission Levy (Variation) Scheme (Confirmation) Order 1988, be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. Alan Howarth.]

Indecent Displays (Newspapers)

Ms. Clare Short: I beg to move,
That leave be given to bring in a Bill to make illegal the display of pictures of naked or partially naked women in sexually provocative poses in newspapers.
The purpose of the Bill is to remove from newspapers pictures of partially naked or naked women in sexually provocative poses and to make the publication of such pictures punishable with a fine relating to the newspaper's circulation. The proposal follows closely the principle of the Indecent Display (Control) Act 1981, which lays down that pictures that might legally be allowed in magazines cannot be put on public hoardings. I believe that the same argument should apply to newspapers.
I first introduced this Bill two years ago and you will recall, Mr. Speaker, that on that occasion the House—particularly a large rump of Conservative Members—misbehaved fairly grossly. With some Conservative support, we won the vote on that occasion, but the Bill failed because a succession of Conservative Members objected each time that it came up for Second Reading. They did not even have the guts to stand up and say who they were, but objected anonymously.
I seek to reintroduce the Bill, partly because of the overwhelming support that the proposal has received since it was introduced. I have received more than 5,000 letters, the overwhelming majority from women but a significant number from men, supporting the proposal. Some of the letters are very moving and distressing. I have received about 12 from women who have been raped and who say that when they were raped the men said that they reminded them of a woman on page 3 or that they ought to be on page 3.
I have received many letters from women who were sexually assaulted and who say that every time they are exposed to such pictures it reminds them of the assault and they find it extremely distressing. I have received hundreds of letters from women who speak about sitting on a bus or the tube or being at work and seeing men reading papers and making comments that offend them deeply. I have received letters from women who have had breasts removed because of cancer and who are deeply hurt when sometimes even their husbands buy newspapers and bring them into the home.
I have received hundreds of letters from teachers who talk about children being asked to bring newspapers into school to cover desks during art lessons. They talk of little boys of six and seven giggling and joking over the pictures, while the little girls do not know what to do. That is some indication of the way in which such newspapers are helping to shape attitudes in our society.
The last category of letters, and perhaps the most upsetting, are those from young women who were sexually abused as children and who talk about the way in which the man who abused them, often the father or a close relative, used such pictures and pornography to justify the sexual abuse.
The overwhelming majority of those who write argue that the pictures degrade women and portray them as sexual objects to be used and taken whenever men feel the need to do so. It is the overwhelming view of those who wrote to me, and it is also my view, that the mass


circulation of these pictures—we are talking about 10 million every day of every week of every year and about twice that number of adults and large numbers of children who see them—helps to create a sexual culture that encourages sexual assaults on women and rape and sexual abuse of women and children.
The wide distribution of such pictures helps to legitimise the harder and nastier porn, the circulation of which is also growing rapidly in our society. Some of those who oppose my Bill argue that they have some sympathy for it but that it would be wrong to censor the press. I should like to address that argument. The British press is owned by a very small number of extremely rich men. It seems quite extraordinary to suggest that that small number of people can define freedom while the rest of us are not allowed to impose some constraints on what they print and circulate. Quite rightly, we have restrictions on material that excites racial hatred. We should also have restrictions on material that degrades women.
It is far from certain that the readers of these newspapers want the pictures. Every easy-to-read newspaper in Britain carries such pictures, but only one of them, The Star, has ever consulted its readers. The majority of those who bought the paper and responded to the poll said that they wanted the pictures to be removed. The last time that I introduced my Bill it was followed by a campaign in one of our lowest level newspapers, the Sun, which wanted to stop "crazy Clare" from introducing the Bill. Readers were asked to send for car stickers and to write using Freepost to say how they objected to the Bill. Ever since that time the Sun has refused to tell anyone how many stickers were circulated and how many people wrote in.
A small number of dirty-minded newspaper owners and editors who despise their readers think that they have to serve up such material in order to sell some of their nasty politics. It is not the wish of the people who buy the newspapers that such material should be widely circulated in our society.
I hope very much that the House will overwhelmingly support this measure. I do not pretend that it will prevent all sexual attacks on women or stop the degradation of women. However, it would be one big step in that direction, and the House should be united in supporting it.

Mr. Eric Forth: This is an intolerant measure and is typical of the authoritarianism we have seen in the modern Labour party. In this I have some sympathy with the right hon. Member for Chesterfield (Mr. Benn), because I am beginning to understand what he is saying about this trait in the modern Labour party.
This measure sits ill with the Opposition's criticisms about the censorship of the press, the authoritarian attitude of Government Members or the Government's attitude towards the press. I hope that Opposition Members will think carefully about that before they vote on this measure.
What upsets Opposition Members is that this matter is about choice. It is about the choice exercised freely every day by millions of people. As the hon. Member for Birmingham, Ladywood (Ms. Short) has admitted,

millions of people in this country exercise their choice freely to purchase newspapers and to look, among other things, at whatever may be displayed in them.
Perhaps more importantly, it is about the choice made by the young ladies themselves as to whether they display themselves in the newspapers. I wonder what it is that the hon. Member for Ladywood finds so objectionable about adult young ladies deciding whether they will exploit the audience for those newspapers. She has talked about the exploitation of them, but I wonder whether she had considered how successfully young ladies choose to display for profit whatever assets they possess and benefit and exploit the male population of this country. It may well be that she wishes to protect the wrong people.
What distinction is made between the honourable place of the nude in the history of art and sculpture and the portrayal—[Interruption.]

Mr. Speaker: Order. We often hear things in the Chamber with which we may disagree.

Mr. Forth: What distinction—

Mr. Brian Sedgemore: Name one painting.

Mr. Forth: For the benefit of the House I will name the sculpture "The Kiss" by Rodin, which is generally accepted as a great work of art and which portrays two naked people in an embrace.

Mr. Sedgemore: Name one painting.

Mr. Forth: Why is it that the prurient minds of Opposition Members see unclad young ladies as being disgusting? [Interruption.]

Mr. Speaker: Order. I am listening with great interest to what is being said, but I cannot hear properly if there are interruptions from below the Gangway.

Mr. Forth: I would cite further the works of Titian or Reubens and many other great artists who have portrayed through the centuries ladies in various stages of undress whose pictures have been regarded as art.
The Bill is defective in its detail—[Interruption.] I do not know why Opposition Members are afraid to hear the argument. Perhaps they are embarrassed by what their hon. Friend is proposing.

Mr. Sedgemore: What Titian painting is the hon. Gentleman talking about?

Mr. Forth: Will the hon. Gentleman settle down?

Mr. Speaker: Order. All I can hear from below the Gangway is some chant about a painting. This Bill is about displays in newspapers.

Mr. Forth: The measure is defective in its detail because the hon. Member for Ladywood failed to tell us who will define what is meant by "partially clad". Who decides between clad, partially clad or unclad? More importantly, and perhaps more relevant, what is a sexually provocative pose? Perhaps the hon. Lady can identify or knows a sexually provocative pose when she sees one, but I do not know whether she expects the readers, editors or publishers of the newspapers so to do. She has not described in the Bill where the responsibility for the identification of "partially clad" or "sexually provocative" will lie.
This is a grossly irresponsible and defective measure, and, for all those reasons, I hope that the House will reject it. It is intolerant and impractical and flies in the face of the freely exercised choice of most people in this country.

Question put, pursuant to Standing Order No. 19 (Motions for leave to bring in Bills and nomination of Select Committees at Commencement of Public Business):—

The House divided: Ayes 163, Noes 48.

Division No. 252]
[3.50 pm


AYES


Abbott, Ms Diane
Foster, Derek


Allen, Graham
Fraser, John


Alton, David
Galbraith, Sam


Ashton, Joe
Garrett, John (Norwich South)


Banks, Tony (Newharn NW)
Gould, Bryan


Barnes, Harry (Derbyshire NE)
Graham, Thomas


Barron, Kevin
Grant, Bernie (Tottenham)


Beckett, Margaret
Griffiths, Nigel (Edinburgh S)


Beggs, Roy
Grocott, Bruce


Beith, A. J.
Hardy, Peter


Bell, Stuart
Hattersley, Rt Hon Roy


Benn, Rt Hon Tony
Haynes, Frank


Bennett, A. F. (D'nt'n &amp; R'dish)
Heffer, Eric S.


Bidwell, Sydney
Henderson, Doug


Boyes, Roland
Hinchliffe, David


Bradley, Keith
Hogg, N. (C'nauld &amp; Kilsyth)


Braine, Rt Hon Sir Bernard
Home Robertson, John


Bray, Dr Jeremy
Hood, Jimmy


Brazier, Julian
Howarth, George (Knowsley N)


Brown, Gordon (Decline E)
Hoyle, Doug


Brown, Nicholas (Newcastle E)
Hughes, John (Coventry NE)


Bruce, Malcolm (Gordon)
Hughes, Robert (Aberdeen N)


Buckley, George J.
Hughes, Robert G. (Harrow W)


Butler, Chris
Illsley, Eric


Caborn, Richard
Janner, Greville


Callaghan, Jim
Jones, Barry (Alyn &amp; Deeside)


Campbell, Menzies (Fife NE)
Jones, Martyn (Clwyd S W)


Campbell, Ron (Blyth Valley)
Kilfedder, James


Campbell-Savours, D. N.
Kinnock, Rt Hon Neil


Canavan, Dennis
Kirkwood, Archy


Clark, Dr David (S Shields)
Lambie, David


Clay, Bob
Lamond, James


Iceland, David
Leighton, Ron


Cohen, Harry
Lewis, Terry


Cook, Robin (Livingston)
Litherland, Robert


Corbyn, Jeremy
Livingstone, Ken


Cormack, Patrick
Livsey, Richard


Cousins, Jim
Lofthouse, Geoffrey


Crowther, Stan
Loyden, Eddie


Cummings, John
McAllion, John


Cunliffe, Lawrence
McAvoy, Thomas


Dalyell, Tam
McCartney, lan


Darling, Alistair
McFall, John


Davies, Ron (Caerphilly)
McKay, Allen (Barnsley West)


Dobson, Frank
McKelvey, William


Doran, Frank
Madden, Max


Duffy, A. E. P.
Mahon, Mrs Alice


Dunnachie, Jimmy
Marek, Dr John


Dunwoody, Hon Mrs Gwyneth
Marlow, Tony


Eadie, Alexander
Martin, Michael J. (Springburn)


Eastham, Ken
Martlew, Eric


Ewing, Mrs Margaret (Moray)
Maxton, John


Fatchett, Derek
Meacher, Michael


Field, Frank (Birkenhead)
Michael, Alun


Fields, Terry (L'pool B G'n)
Michie, Bill (Sheffield Heeley)


Flynn, Paul
Michie, Mrs Ray (Arg'l &amp; Bute)


Foot, Rt Hon Michael
Millan, Rt Hon Bruce


Forsythe, Clifford (Antrim S)
Moonie, Dr Lewis





Morgan, Rhodri
Smith, C. (Islton &amp; F bury)


Morley, Elliott
Smith, Rt Hon J. (Monk'ds E)


Mowlam, Marjorie
Spearing, Nigel


Mullin, Chris
Squire, Robin


Nellist, Dave
Strang, Gavin


Nicholson, Emma (Devon West)
Straw, Jack


Oakes, Rt Hon Gordon
Tapsell, Sir Peter


O'Brien, William
Taylor, Mrs Ann (Dewsbury)


Orme, Rt Hon Stanley
Thomas, Dr Dafydd Elis


Parry, Robert
Turner, Dennis


Patchett, Terry
Vaz, Keith


Pike, Peter L.
Wall, Pat


Radice, Giles
Wallace, James


Redmond, Martin
Wareing, Robert N.


Rhodes James, Robert
Welsh, Andrew (Angus E)


Rooker, Jeff
Welsh, Michael (Doncaster N)


Ross, Ernie (Dundee W)
Widdecombe, Ann


Rossi, Sir Hugh
Williams, Alan W. (Carm'then)


Rowlands, Ted
Wilson, Brian


Ruddock, Joan
Winnick, David


Sedgemore, Brian
Worthington, Tony


Sheldon, Rt Hon Robert



Shephard, Mrs G. (Norfolk SW)
Tellers for the Ayes:


Short, Clare
Mrs. Ann Clwyd, and


Skinner, Dennis
Ms. Jo Richardson.


Smith, Andrew (Oxford E)





NOES


Adley, Robert
Heathcoat-Amory, David


Alexander, Richard
Hicks, Mrs Maureen (Wolv' NE)


Arnold, Jacques (Gravesham)
Holt, Richard


Atkinson, David
Jessel, Toby


Banks, Robert (Harrogate)
Johnston, Sir Russell


Beaumont-Dark, Anthony
Jones, Robert B (Herts W)


Biggs-Davison, Sir John
Kirkhope, Timothy


Blackburn, Dr John G.
Lawrence, Ivan


Brittan, Rt Hon Leon
MacKay, Andrew (E Berkshire)


Budgen, Nicholas
Moate, Roger


Butterfill, John
Oppenheim, Phillip


Carlisle, John, (Luton N)
F'aice, James


Carttiss, Michael
Redwood, John


Coombs, Anthony (Wyre F'rest)
Riddick, Graham


Coombs, Simon (Swindon)
Shaw, David (Dover)


Couchman, James
Shaw, Sir Michael (Scarb')


Day, Stephen
Stewart, Allan (Eastwood)


Emery, Sir Peter
Taylor, Ian (Esher)


Farr, Sir John
Tebbit, Rt Hon Norman


Fearn, Ronald
Warren, Kenneth


Fox, Sir Marcus
Whitney, Ray


Goodson-Wickes, Dr Charles
Wiggin, Jerry


Gow, Ian



Gregory, Conal
Tellers for the Noes:


Grylls, Michael
Mr. Eric Forth and


Haselhurst, Alan
Mr. Jerry Hayes.

Question accordingly agreed to.

Bill ordered to be brought in by Ms. Clare Short, Ms. Jo Richardson, Mrs. Margaret Beckett, Mrs. Alice Mahon, Mrs. Ann Clwyd, Mr. John Battle, Mr. Bill Michie, Mrs. Ann Taylor, Mrs. Margaret Ewing, Ms. Diane Abbott, Ms. Marjorie Mowlam and Miss Emma Nicholson.

INDECENT DISPLAYS (NEWSPAPERS)

Ms. Clare Short accordingly presented a Bill to make illegal the display of pictures of naked or partially naked women in sexually provocative poses in newspapers: And the same was read the First time; and ordered to be read a Second time upon 6 May and to be printed. [Bill 140.]

Social Security System (Changes)

Mr. Speaker: I have received an enormous number of applications from hon. Members on both sides of the House to take part in the debate. It would be extremely helpful if both Front Bench speakers would make brief speeches and if Back-Benchers would confine their speech to five minutes. There is hardly a constituency that is not affected by the changes in one way or another. It is my wish that most of those who want to take part in the debate should be able to do so.

Mr. Robin Cook: I beg to move, That this House do now adjourn.
Leave having been given on Tuesday 12 April under Standing Order No. 20 to discuss:
The impact of the changes in the social security system.
Today we are debating the impact of the social security changes that have been phased in over the past fortnight. The Government claim that these changes represent the biggest upheaval in social security in 40 years. It is certainly the biggest upheaval since the Government came to power, but I would not want it to be thought that this Government have been idle over the past nine years. In that time they have abolished the link between pensions and earnings, which means that the pension for a married couple is £14 less than it would otherwise be.
The Government have also abolished the short-term sickness benefit and the earnings-related supplementary unemployment benefit and they have taken what is left of unemployment benefit into taxation. They have repeatedly not uprated child benefit, so that it is now worth almost 10 per cent. less than it was worth in 1979, in real terms. They have removed the board and lodging allowance from all claimants under 25 on social security and, worst of all, over the past two years they have just about halved expenditure on single payments. That is quite a record.
Against that background, it took real determination to succeed in devising a new system that was even more mean than the one that it replaced and that leaves some people even worse off than they were under the previous system. The question at the heart of the debate is how many are worse off. Everyone on the Treasury Bench, from the Olympian height of the Prime Minister to the humble and retiring manner of the Under-Secretary of State for Health and Social Security, the hon. Member for Derbyshire, South (Mrs. Currie), has asserted that only 12 per cent. will be worse off as a result of the changes. It may help if I clarify the basis of that claim. It is based on two sources of data.
The first is a sample of claimants on supplementary benefit that was taken in February 1986, two years ago. The second is a family expenditure survey of data collected in 1985, three years ago. It is not a careful census of 8 million people affected by the changes. It is an estimate based on a sample that is small in relation to the millions affected, and it is a sample taken at a time so long ago that most of those who are now on social security were not claiming it at the time. It is also a calculation that wondrously treats the abolition of single payments as not being a cut at all.
The problem for the Secretary of State and for his Government colleagues in defending that estimate is that no organisation that has studied the impact of last week's changes agrees with it. Ministers and this Government are

the victim of their own arrogance. They arrogantly believe that nobody deserves to be listened to and taken seriously unless they are employed by and working within the Government.
There was a superb example of that arrogance yesterday during the exchanges at Prime Minister's Question Time from the hon. Member for Mid-Worcestershire (Mr. Forth), who played such a distinguished part in our proceedings earlier this afternoon. When my hon. Friend the Member for Dundee, West (Mr. Ross) referred to the citizens advice bureaux and suggested that they were not militant, the hon. Member for Mid-Worcestershire interjected in his characteristically urbane fashion and said that they are all Trots. I am bound to say that that casts a new light on Sir Kenneth Clucas, the chair of the National Association of Citizens Advice Bureaux, new light that the security services would be interested in receiving, as Sir Kenneth was for three years a permanent secretary under this Government.
It is a measure of the Government's lack of confidence that they have commissioned no research of their own into the effect of these changes. I suggest that they ought to look at the work of bodies that have carried out research into the changes, such as the Policy Studies Institute. They cannot all be Trots. Indeed, the Government commissioned research from the Policy Studies Institute. As the director of the institute pointed out last month, the Government have ignored all the results of its research in preparing the new social security system, even though the institute was considered to be reliable enough to be commissioned to undertake research. Last month, the Policy Studies Institute calculated that the losers are not 12 per cent. but 48 per cent. That may not be a reliable figure, because the PSI based its calculation on data supplied by the Department of Health and Social Security.
Let me turn to the Oxford department of social administration, which wisely shunned information from the DHSS and carried out a study of 186 claimants in Oxford during the past month. It concluded that two thirds of them lose in cash terms, even if we do not count the abolition of single payments, and that three quarters lose in cash terms if we count the abolition of single payments. The research unit at Nottingham university has studied Nottingham on a ward-by-ward basis. Wandsworth has also been studied on a ward-by-ward basis on behalf of Wandsworth council—another well-known bunch of Trots. Both studies discovered that the losers outnumbered the gainers by 2:1.
Since I represent a Scottish constituency, let me pray in aid Strathclyde social work department. It studied 200 claimants last month and concluded that 154 of them would be worse off in cash terms. Like the Oxford study, but unlike the Government's figures, that is not an estimate; it is a head count of real claimants from samples that date not from 1985 but from 1988.
Ministers cannot even convince their own staff who daily see the claimants. Those staff, in advance of the changes, have insisted on floor to ceiling security to protect them from the frustration that they expect from claimants.
Perhaps the unkindest cut of all comes from the Social Security Advisory Committee, set up by the present Government as a source of independent, authoritative advice which they could then ignore. Last week, the committee produced its annual report. The chairman, Mr. Peter Rarclay—another unconscious Trotskyist—put the


losers not at 12 per cent., but at 43 per cent. That figure has since been quoted as that of the Social Security Advisory Committee. In fairness, it should be put on record that it is not the committee's figure; it is the Government's own figure. It dates from the tables produced by them in November, which showed that 3,650,000 claimants would be better off if they simply kept the old scheme and uprated it by 3 per cent. for inflation.
With all its faults—with all the cuts that I paraded at the start—and not even taking into account the abolition of single payments, 3,650,000 claimants are worse off under the new scheme than under the old one. We can only conclude that Ministers consider that the principal fault of the old scheme was that it was too generous to too many people. Yet the Prime Minister persists in stating that 88 per cent. are better off, or no worse off. She reaches that simple conclusion on the basis that, although many people now have a lower entitlement to benefit, the DHSS does not actually take the cash away from them. Even the present Government shrank from that step. Instead, they simply let the benefit shrivel away with inflation.
One claimant among that 88 per cent. is Mr. St. Clair, a resident of Cornwall. His wife had a stroke two years ago, and since then has been paralysed. The only movement that she can make is to blink her eyelids. Mr. St. Clair left work two years ago to nurse her. She cannot swallow, because she is totally paralysed, and therefore all her food must be liquidised, which is an expensive process.
To be fair, the local DHSS staff appear to have pulled out all the stops to give Mr. and Mrs. St. Clair the maximum help. They currently receive £89 a week in benefit. Under the new rules, they are entitled to £70 a week. Of course, Mr. and Mrs. St. Clair are not losers. Their cash is not being taken away. Their benefit has been frozen at its present level until their new entitlement catches up, which at the present rates of inflation will mean their benefit remaining frozen until 1995. Nevertheless, they are among the 88 per cent. paraded as being no worse off.
It is worse than that, however. Mr. and Mrs. St. Clair advise me that they live in a two-storey cottage. Every night Mr. St. Clair carries his wife up and down the stairs. He had arranged to buy a single-storey bungalow. An additional £9 would be paid to him by the DHSS to cope with the additional cost. Under the new rules, that £9 is not added to his cash benefit; it is only added to his notional entitlement under the new rules, bringing that entitlement up to £79—less than its present level in cash—and leaving Mr. and Mrs. St. Clair not a penny better off. The purchase of the bungalow has fallen through and, every night, Mr. St. Clair carries Mrs. St. Clair up and down the stairs. None the less, we are told by the Prime Minister and every Minister in the Government that Mr. and Mrs. St. Clair are not losers.

Mr. David Harris: This is a very complicated case. As the hon. Gentleman may appreciate, I had some dealing with it over a period. There is a conflict between the figures that I was given and those that the hon. Gentleman has given. I was told that, as the hon. Gentleman has said, until now the supplementary benefit payment to the St. Clairs has been £89·73 a week, but that income support has been awarded at £93 a week. There may be a reason for the difference between the figures, but I consider it only right that my figures should be put on the record.

Mr. Cook: I am obliged to the hon. Gentleman for his intervention. My figures, however, come straight from Mr. St. Clair, with whom I discussed the matter only last week. Of course, I shall be happy to check them again, but I assure the hon. Gentleman that when I last conversed with Mr. St. Clair he clearly believed that not only had he been left worse off and unable to purchase the house that he needed, but, without a shadow of a doubt, he was a loser in real terms from the changes brought in by the Government.
There is, of course, an added lesson to be learnt from that case: that any disabled person now about to claim for the first time will start at the new levels of benefit. Just how hard they will be hit is shown by the study produced by 15 citizens advice bureaux, based on 80 claimants who came to the bureaux for two days in early March. Forty-four of them will receive lower benefits under the new scheme if applying for the first time after 11 April.
Those who lose most are the old and the sick. That is not surprising, because a key feature of the new scheme is that it sweeps away all the extra additions for the special needs of the disabled and frail, such as diet, heating and laundry: all the additions to which a former Minister of State with responsibility for social security—now the Minister for Health—once referred in a television interview as the twiddly bits of the system. It is, of course, those "twiddly bits" that made life bearable for the disabled.
Of 20 pensioners in the study, 14 will be worse off under the new scheme. Of 19 disabled claimants, 16 will be worse off. Again, those are not estimates. They are not based on a computer model. They are actual assessments of real claimants who came to those bureaux only a month ago. They are deeply disturbing figures, and they are even more disturbing given that every year one third of the claimants who come on to the books of the social security system do so for the first time. In other 'words, next April one third of all claimants of income support will be assessed under the new rules, and if the experience of the citizens advice bureaux is any guide, more than half those new claimants will receive less under the new system than they would under the previous system, with all its faults.

Mr. Allan Roberts: Will my hon. Friend bring to the Minister's attention the ending of the transitional protection arrangements that existed before the new schemes came in? One of my constituents, Mrs. Margaret Wells, is in a home for people suffering from senile dementia, and has only £400 in savings. However, she had to leave behind a terraced house that the DHSS estimates now to be worth more than £6,000. Her payments for her stay in the home are being cut off, and her relatives are being told that, because they cannot afford the extra £100 that they must find, they must borrow: they must go into debt to pay it. Is that the kind of thrift that the Prime Minister is advocating?

Mr Cook: A number of my colleagues have encountered identical cases, including my hon. Friend the Member for Bishop Auckland (Mr. Foster), two of whose constituents have lost £140 a week—money that they required to meet the fees of their accommodation in residential homes. I know that the Secretary of State has received a letter from the Association of Hospice Social Workers asking to take up that point with him. I hope that he will tell us that he will do the association the courtesy,


and show the courage, of meeting its members and considering their objections to a rule that is causing so much harshness.

Mr. Kenneth Hind: rose—

Mr. Cook: No, I shall not give way. Mr. Speaker has very properly advised the House that many hon. Members wish to speak. I should like to proceed with my speech.
There is common ground between the Government and the Opposition. Both sides accept that there are cash losers. Even the Prime Minister accepts that. Let us now consider who those losers are. Let us ask whether their losses are acceptable, even if they are only 12 per cent., or 960,000, a figure to which the Government admit. There can be few hon. Members who have visited their constituencies in the past fortnight who have not met some of those losers. Last weekend, in my constituency, I met a couple on invalidity benefit of £72 a week who have lost £11 a week in housing benefit—£44 a month. They have not £6,000 to their name. But 350,000 lose all their benefit and will experience an even worse impact on their living standards as a result of that rule.
Yesterday, my right hon. Friend the Leader of the Opposition referred the House to the case of Mrs. Williams. Let me refer the House to the case of Mrs. Phillips of Crewe. Mrs. Phillips received £41 in state pension and £12 in interest per week—a grand sum of £53 weekly. She received the interest on a capital sum of £9,000. Because the sum is over £6,000, last week she lost all her housing benefit. That increased her rent and rates by £12 a week.
Until last week, after housing and fuel costs, Mrs. Phillips was left with £33 per week for food, clothing and every other necessity. She is now left with £23 a week for those expenses. How many Conservative Members imagine that they could manage on that income per week? I know that some of them have had the courage to admit that they could not. I know that because some of them have been confronted by constituents hit by the new rule. I read in the press that the hon. Member for Mid-Kent (Mr. Rowe) has been advising those caught by the rule that they should put a deposit on their funeral with an undertaker in order to get below the £6,000 ceiling.
There is a much simpler and more effective way of solving the problem of the hon. Gentleman's constituents, and that is for him to use his vote in the House, to which his constituents sent him, to force the Government to change a rule that he will not defend.
Nor is it just those on housing benefit who lose. There are the 15,000 people who lose all social security because they or their partners work more than 24 hours a week. Among those 15,000 people are Mr. and Mrs. Godden, to whom I referred yesterday. Before I close, I wish to dwell on their case.
Mrs. Godden suffers from multiple sclerosis. That is a degenerative condition. It will get worse, not better. Already Mrs. Godden can barely walk the length of her house. She has three young daughters, the youngest of whom is two years old and the oldest is eight years old. She has a mentally handicapped son who stays in a hospital during the week and returns home at weekends. For such a household she needs constant attendance.
There is one solution—it is rapidly becoming the only solution available to the Goddens—and that is for Mr. Godden to give up his work and stay at home and for the family to live entirely on social security. Mr. Godden has chosen not to do that. To his credit, he has struggled to hold down his job—a job that involves him working six days a week from 9 am to 6 pm, for which he takes home £128 a week.
Mr. Godden is precisely the kind of person whom Conservative Members constantly tell us they want to support—people who choose to work for a low wage rather than go on the dole. It costs Mr. and Mrs. Godden £120 to secure constant attendance while Mr. Godden works. The net gain from Mr. Godden's work is £8. Under the old rules, the Goddens qualified for social security of £48 a week. Now they do not qualify for a penny.
There is another twist. The Secretary of State yesterday advised the House that their accommodation was rent-free. That is perfectly true. It is rent-free because it is tied accommodation. If Mr. Godden now gives up his job, as he may be obliged to do, the family will in turn be rendered homeless.
Mr. and Mrs. Godden came to Parliament before Easter. They spoke to a press conference of the parliamentary lobby in the Palace—possibly the most hardened and cynical audience known to man. Nevertheless, it was obvious that they were moved by Mr. and Mrs. Godden's plight. It is the mark of a civilised and decent society how it supports families in Mr. and Mrs. Godden's position; how it helps them to struggle to hold together their marriage and their children to prevent them from going into care. That is the nightmare that haunts Mrs. Godden, because, by a wicked irony, she herself was brought up in care.
I shall never forget the reception that her case received in the House yesterday. It was received on the Government Benches with laughter. What Conservative Members found funny was the Secretary of State's observation that the Goddens had been on holiday. They found it the biggest joke of the day that a disabled claimant had taken her children on holiday, as if people on benefit should be under a kind of house arrest.
Yes, all right, Mr. and Mrs. Godden had a holiday. It lasted six days and it ended 12 days ago. They went to Plymouth to see Mrs. Godden's relatives. Mr. Godden is a caravan salesman. His company gave him free use of a caravan for a week. They parked it in a farmer's field at a rent of £2 a night. That, and the petrol from Bristol, was the entire cost of the holiday that Conservative Members found so funny.
However, there is something that the Government have done to help the Goddens. It would be churlish of me not to refer to it before closing. As a result of the Budget, Mr. Godden's weekly net income has gone up to £130. He has gained £2 from tax cuts while losing £48 from benefit cuts.
Here we come to the final and shaming contrast—the contrast between tax cuts in March and benefit cuts in April. There need not have been any losers from the social security changes. We know that the Government had the money to prevent there being any losers. We know that because the Chancellor found £2,080 million to give to 750,000 top rate taxpayers only last month. There was no talk of targeting there in the Budget speech; no talk of concentrating help where it was most needed last month. The Chancellor actually gave away more money to 750,000 of the rich than the entire increase in the social


security budget for 12 million claimants. That tells us all that we need to know about the Government's priorities. This is a Government who help the rich and punish the poor, and it is against those priorities that we shall vote tonight.

The Secretary of State for Social Services (Mr. Moore): It is extraordinary that the Opposition should call for an emergency debate—[Interruption.]

Mr. Speaker: Order. The Opposition spokesman was heard in silence and I hope that the House will give an equally fair hearing to the Secretary of State.

Mr. Moore: As I started to say, it is extraordinary that the Opposition should call for an emergency debate on the social security changes as though anything that occurred on Monday had not been discussed and debated repeatedly—I am talking, Mr. Speaker, to the Opposition—and in minute detail, over the past months, and, indeed, years. In fact, the changes had been under scrutiny, in the House and elsewhere, since the review process started back in 1983 and 1984.
For example, the Opposition will be aware that the Social Security Act 1986, which provided the legislative basis for the changes, was debated for over 234 hours—a similar length of time to that given to the equivalent legislation in the 1940s. In Committee, 162 hours were spent in 42 sessions considering 1,498 amendments. The changes—[Interruption] There is time for me to make all the points that I am seeking to make. The changes were incorporated in the manifesto on which the Conservative party won the election. Finally, the detailed regulations for the new schemes and other changes this month were the subject of numerous further debates here and in another place.
Before I proceed—I shall endeavour to be as brief as I can in view of your comments, Mr. Speaker—I want to respond briefly to the detailed points on Mrs. Godden made by the hon. Member for Livingston (Mr. Cook). It is extremely difficult for those of us who are concerned about the genuine interests of benefit claimants, as I know the hon. Gentleman is, to seek to debate such matters across the Floor of the House. I sought yesterday, and I do so again now, to make certain that the facts were there—the facts that related to the inability of the local social services department and my Department to establish whether, on the Independent Living Fund or on additional facilities, the local social services could assist.
In the light of the hon. Gentleman's comments it might therefore be useful again to remind the House of the inaccuracies in the report in one of yesterday's newspapers. The mobility allowance—[Interruption.] It is useful for the House to know the facts if an individual case is being raised. Obviously we all welcome the fact that the family receives £23·05 a week in mobility allowance, which was not mentioned. The general increase in benefits this week brought the total benefit income up to £117·30 a week. There was an increase in the husband's wages to £130 a week and, as the hon. Member for Livingston rightly said, there is no liability to pay rent or rates. There was also no mention of the presence in the home of a non-dependent son who is in full-time work.
Together, those facts paint a different picture. After the changes this week, and prior to the application that will be

considered under the independent living fund, Mrs. Godden has a weekly income of £247·70 for a family of five, with no rent or rates to pay, and a working son living at home. I am just reminding the House of the facts of the case.
We should put the changes this week into context. The hon. Member for Livingston failed to address the real problems of the old benefit system. Indeed, by every—

Mr. Neil Kinnock: I am grateful, not only for the Secretary of State giving way, but for his attention to detail. Will he confirm that of the £247 of which he spoke £120 has to be spent because of the constant attendance requirements of Mrs. Godden? That is the price of a mother having multiple sclerosis. The effective income of the family is not, therefore, £247 a week, but £127 a week.

Mr. Moore: If we want to be even more accurate, the right hon. Gentleman is right in that particular, but his facts are incomplete. He is right to say that the private domestic help that Mrs. Godden is receiving is currently running at a cost of £125·38 a week. The local social services have visited her since I spoke yesterday and have offered—[Interruption.]

Mr. Speaker: Order. The Secretary of State was asked a question and he is now seeking to reply to it.

Mr. Moore: The social services have offered assistance with domestic help, which has been refused.
The hon. Member for Livingston failed to address the real problems of the old benefits system. Indeed, by every comment and criticism that he makes of our changes, he implies that he would prefer to keep the old system in its old shape indefinitely into the future. If that is not his position, he holds out the absurd illusion that, in reforming a highly complex and frequently unbalanced structure into something more coherent and sensible, it is possible to leave everybody, even those who have benefited from the anomalies of the old system, just as well off as if the old system had been continued. Frankly, as all hon. Members know, that is a delusion.
What were the problems of the old structure of benefits? First—this is something on which many people of all political opinions will agree—the old structure was not sufficiently responsive to changes in society and to changing needs. The 1985 Green Paper, which launched. the reform process, showed that there had been important changes in the characteristics of those in the lowest income groups over the previous decade or so. In particular, the growing prosperity of pensioners meant that there were far fewer of them in the lowest income group by the early 1980s than there had been 10 years previously. Indeed, on average, pensioners' net incomes rose by 18 per cent. in real terms. [Interruption.]

Mr. D. N. Campbell-Savours: We cannot hear the Secretary of State.

Mr. Speaker: Order. If the House is silent, hon. Members will be able to hear the Secretary of State.

Mr. Moore: Indeed, on average, pensioners' net incomes rose by 18 per cent. in real terms between 1979 and 1985; twice as fast as in the population as a whole, and very much faster than in the mid-1970s.

Mr. David Winnick: rose—

Mr. Moore: By contrast, the Green Paper showed an increase in the number of families, with children, on relatively low incomes and concluded that the social security system needed to be more responsive to their particular needs.

Mr. Winnick: rose—

Mr. Frank Field: rose—

Mr. Moore: I should like to get further into my speech.
Secondly, the old structure tended to lock recipients into dependency rather than to liberate them from it. Too many people were in a position in which, if they sought to improve their position or that of their families, they could find themselves worse off as a result.
The absurdity of that situation can be shown in the case of a married couple, with three children aged three, eight and 11, paying average local authority rent and rates. Under the old structure, on gross earnings of £070 a week, they would have had, including benefits, a total net income of £111·80. However, if their gross earnings more than doubled, to £150, they would have been over £1 a week worse off. That was not only a ludicrous situation, but was deeply immoral. The system said, "If you want to better yourself, look to the state for help and not to your own efforts."

Mr. Dave Nellist: rose—

Mr. Moore: In addition to the complexities within each benefit, there was no real coherence between them, so that supplementary benefit and housing benefit—[Interruption.] I am trying to illustrate the kinds of complexities and problems that existed in the past in a way that I think most people would appreciate hearing. There was no real coherence between them, so that supplementary benefit, housing benefit and family income supplement each had its own rules and its own fine print to cover what were often much the same issues. It was a recipe for complexity, confusion and anomaly and it was emphatically not a satisfactory basis for the future.
The need for reform was therefore clear. Huge resources were going into social security. In 1978–79, about £16 billion was spent on benefits, and in the last financial year that had reached over £44 billion. Even after discounting inflation, there had been a real terms increase approaching 40 per cent., or over £12 billion, at current prices, but despite that record expenditure, the system was clearly not working. The reforms introduced this month are designed to tackle those very real and pressing problems.

Mr. Nellist: rose—

Mr. Winnick: rose—

Mr. Moore: All three income-related benefits are now far more closely aligned, achieving greater coherence between the help available to those on low incomes, whether in work or out of work, improving work incentives—

Mr. Winnick: rose—

Mr. Moore: —and achieving a simpler and more straightforward structure.

Mr. Nellist: rose—

Mr. Speaker: Order. May I say to those hon. Members who are now seeking to interrupt that it takes time out of the debate and also takes time away from those who may wish later to make contributions.

Mr. Moore: The new structure will make it easier for claimants to understand what is available and what they should receive. Equally important, it makes it possible to ensure that resources are directed to the priority groups which need them most. For example, we are using this new flexibility to give particular emphasis to the needs of families with children.
So far, I have spoken mainly—

Mr. Nellist: rose—

Mr. Moore: —about regular weekly benefits, but the system of one-off payments for exceptional needs was also included in the reform. The single payments scheme no longer achieved its aim—

Mr. Nellist: What is the Secretary of State scared of?

Mr. Moore: —nor did it direct taxpayers' money to those who needed it most. In particular, it was no longer a system of exceptional payments. In 1949, exceptional needs payments—

Mr. Nellist: rose—

Mr. Speaker: Order. The hon. Gentleman is one of those who have told me that they wish to take part in the debate. He cannot expect to intervene and also to make a speech.

Mr. Moore: As I was saying, it was no longer a system of exceptional payments. In 1949, exceptional needs payments were made at the rate of one for every 10 people on benefit. By 1979, that had become one for every three. Since 1980, the cost had been doubling every two years.

Mr. Nellist: rose—

Mr. Moore: The facts in relation to the appalling old system are relevant.
That was out of all proportion to the increase in the number of people on benefit. In place of single payments, we have therefore introduced the social fund. As the hon. Member for Livingston rightly said, this has attracted a great deal of comment, but let us keep it in perspective. Single payments represented a tiny proportion of the total expenditure on social security and the budget for the social fund will be at about the same level as the cost of those payments in the last financial year.

Mr. Nellist: Give way.

Mr. Moore: Rightly, in my view, the vast bulk of social security goes on regular weekly benefits.

Mr. Nellist: rose—

Mr. Speaker: Order. I must tell the hon. Member for Coventry, South-East (Mr. Nellist) for the last time that he must not persist in rising if the Minister does not give way.

Mr. Nellist: rose—

Mr. Speaker: Order. There is no challenge to that.

Mr. Nellist: On a point of order, Mr. Speaker.

Mr. Speaker: Order. I hope that the hon. Member for Coventry, South-East is not trying to ask his question through the Chair, which would be an unfair tactic.

Mr. Nellist: Not at all, Mr. Speaker. My point of order is that if I rise every minute or every two minutes to ask the Secretary of State to give way, that is my perfect right as a Member of Parliament to try to put my point of view. This is the only chance that I get to ask the Secretary of State questions.

Mr. Speaker: The hon. Gentleman has a right, but equally he is aware of the rules. If the Minister does not give way, or indeed if the hon. Gentleman is speaking and does not give way, another hon. Member seeking to intervene must not persist.

Mr. Moore: I want to consider the effects of the changes—this was the gravamen of the argument presented by the hon. Member for Livingston—on the incomes of claimants. Many scare stories have been thrown around on those effects and I want to clarify the position.
I want, first, to refer briefly to the point raised by the hon. Member for Livingston when he referred to the Policy Studies Institute, the Oxford study, the Wandsworth study and others. One of the problems with most of those studies, as opposed to the Government's data, is that they—the PSI study is an example—underplay the spending on transitional protection.

Mr. Nellist: Will the Secretary of State give way?

Mr. Moore: All the studies to which the hon. Member for Livingston referred—[Interruption.] I am trying to respond to the precise questions raised by the hon. Member for Livingston. All the studies in question made misleading comparisons by quoting average single payments figures for all income support families with children in the way in which the PSI did. They also misleadingly estimated single payments figures which predate the necessary changes made in 1986 and 1987.
Perhaps I should now repeat the basic point that we cannot move away from an old, complex, unbalanced and ultimately unsatisfactory system to something—

Mr. Winnick: Give way.

Mr. Moore: —fairer and more equitable without in the process having both gainers and losers, and in that respect I recognise the point made by the hon. Member for Livingston.
What are the effects? I believe that the Government have been completely frank and open about the likely impact of the changes and we published detailed tables, based on the best available data, in 1985 and last October. We have shown the results in structural terms and in terms of the cash position of those on benefits at the time of change. I want to explain that distinction, because I accept entirely what the hon. Member for Livingston said when he claimed that this was a very important point.

Mrs. Alice Mahon: Will the Secretary of State give way?

Mr. Moore: I am trying as courteously as I can to respond to the basic points made by the shadow Social Services spokesman.

Several Hon. Members: rose—

Mr. Speaker: Order. This is a very brief debate. In fairness to the whole House, I ask the House—

Mr. Nellist: I asked the Secretary State to give way first.

Mr. Speaker: Order. If the hon. Member for Coventry, South-East (Mr. Nellist) rises again and the Minister does not give way, I will have to ask him to leave the Chamber.

Mr. Moore: I am trying to address the very precise and important points made by the hon. Member for Livingston.
The structural tables describe an essentially hypothetical position, as they compare the position of recipients as they will be this year with the position that they would have been in had the old system of weekly benefits continued completely unchanged, but uprated on 11 April in line with inflation.
The tables are also hypothetical in the sense that they compare weekly benefit entitlement under the old scheme, had it continued, with the new scheme, but without taking account of the transitional protection which many beneficiaries will receive on top of their actual entitlement under the new schemes. I accept that that is an unavoidable difficulty with such tables, but it is important for anyone making serious comparisons or looking at the issue seriously to bear that point in mind. It means that, if used in isolation, the structural tables understate the true level of resources that the Government are committing to income-related benefits at the point of change.

Mr. Nellist: rose—

Mr. Moore: The cash tables, which we have also published, give a clearer picture of the actual situation which real benefit—[Interruption.] I shall come in a moment to the precise figures which the hon. Member for Livingston rightly asked me to mention. The cash tables show the actual situation which real benefit recipients will experience this month.
The tables show the numbers who see an increase, decrease or no change in their weekly income at the time of transition, taking account of the changes in rules and benefit rates and the transitional cash protection that we are providing for those in the most vulnerable position—those on income support who would otherwise be worse off.
I expect that some of the confusion arises from a misunderstanding of the fact that, as the hon. Member for Livingston said, last October we published figures on both those bases. For instance, some have claimed to see an inconsistency between the Government's figures and those of the Social Security Advisory Committee. There is no discrepancy for, as the hon. Member for Livingston rightly said, the committee was simply quoting from the Government's structural tables.
The hon. Member for Livingston claimed yesterday that the SSAC figures were new. We are discussing the very points raised by the hon. Member for Livingston yesterday. He cited the fact that the figures were new, in order to justify today's emergency debate. In doing so, I believe that he has shown once again that he does not read what the Government publish and that he has not taken in the figures placed in the Library—

Mr. Nellist: rose—

Hon. Members: Name him.

Mr. Speaker: I must now ask the hon. Member for Coventry, South-East to leave the Chamber.

Mr. Nellist: On a point of order, Mr. Speaker.

Mr. Speaker: Order. There is no point of order arising from this. Will the hon. Gentleman please leave the Chamber? If he does not leave the Chamber, I shall be forced to name him, and that takes time out of the debate.

Mr. Nellist: On a point of order, Mr. Speaker.

Mr. Speaker: There is no point of order. The hon. Gentleman should leave the Chamber.

Mr. John Hughes: On a point of order, Mr. Speaker.

Mr. Speaker: I give the hon. Member for Coventry, South-East one more chance. Will he now leave the Chamber?

Mr. John Hughes: Will you answer a point of order, Mr. Speaker?

Mr. Speaker: Order. I name Mr. Dave Nellist.

Mr. Bob Clay: Tory stooge.

Motion made, and Question put, pursuant to Standing Order No. 43 (Order in debate),
That Mr. Dave Nellist be suspended from the service of the House.—[Mr. Waddington.]

The House proceeded to a Division—

Mr. Anthony Nelson: (seated and covered): On a point of order, Mr. Speaker. At the point when this Division was called and in the seconds thereafter the hon. Member for Sunderland, North (Mr. Clay) was distinctly heard to refer to you as a Tory stooge. In so doing he gave great offence not only to the House but to yourself. I think that this is an appropriate point at which to raise this matter and insist that some action be taken about it as soon as the Division is over.

Mr. Speaker: In the noise that ensued after I had named the hon. Member, I heard no allegation of that kind.

Hon. Members: Oh.

Mr. Speaker: Order. I hope that the whole House will always support its Speaker when he has to do his duty, however painful and difficult.

The House having divided: Ayes 270, Noes 32.

Division No. 253]
[4.47 pm


AYES


Adams, Allen (Paisley N)
Bennett, Nicholas (Pembroke)


Adley, Robert
Benyon, W.


Aitken, Jonathan
Bevan, David Gilroy


Alexander, Richard
Biggs-Davison, Sir John


Alison, Rt Hon Michael
Blackburn, Dr John G.


Arnold, Jacques (Gravesham)
Blair, Tony


Arnold, Tom (Hazel Grove)
Blaker, Rt Hon Sir Peter


Ashby, David
Bonsor, Sir Nicholas


Ashdown, Paddy
Boscawen, Hon Robert


Aspinwall, Jack
Boswell, Tim


Atkinson, David
Bowden, Gerald (Dulwich)


Baldry, Tony
Bowis, John


Banks, Robert (Harrogate)
Boyes, Roland


Barnes, Mrs Rosie (Greenwich)
Boyson, Rt Hon Dr Sir Rhodes


Barron, Kevin
Braine, Rt Hon Sir Bernard


Beaumont-Dark, Anthony
Brandon-Bravo, Martin


Beith, A. J.
Brazier, Julian


Bell, Stuart
Brittan, Rt Hon Leon


Bellingham, Henry
Bruce, Ian (Dorset South)


Bendall, Vivian
Buchanan-Smith, Rt Hon Alick





Buck, Sir Antony
Holt, Richard


Budgen, Nicholas
Hordern, Sir Peter


Burns, Simon
Howarth, G. (Cannock &amp; B'wd)


Burt, Alistair
Howell, Ralph (North Norfolk)


Butler, Chris
Hughes, Robert (Aberdeen N)


Campbell, Menzies (Fife NE)
Hughes, Robert G. (Harrow W)


Carlile, Alex (Mont'g)
Hunt, David (Wirral W)


Carlisle, John, (Luton N)
Hunt, John (Ravensbourne)


Carlisle, Kenneth (Lincoln)
Irvine, Michael


Carrington, Matthew
Irving, Charles


Carttiss, Michael
Jack, Michael


Cartwright, John
Jackson, Robert


Cash, William
Jessel, Toby


Chapman, Sydney
Johnson Smith, Sir Geoffrey


Churchill, Mr
Johnston, Sir Russell


Clark, Dr Michael (Rochford)
Jones, Robert B (Herts W)


Clark, Sir W. (Croydon S)
Kellett-Bowman, Dame Elaine


Coombs, Anthony (Wyre F'rest)
Kilfedder, James


Coombs, Simon (Swindon)
Kinnock, Rt Hon Neil


Couchman, James
Kirkhope, Timothy


Cunningham, Dr John
Kirkwood, Archy


Currie, Mrs Edwina
Knapman, Roger


Curry, David
Knight, Greg (Derby North)


Day, Stephen
Knowles, Michael


Devlin, Tim
Knox, David


Dewar, Donald
Latham, Michael


Dobson, Frank
Lawrence, Ivan


Durant, Tony
Lennox-Boyd, Hon Mark


Emery, Sir Peter
Lightbown, David


Fallon, Michael
Lilley, Peter


Farr, Sir John
Livsey, Richard


Favell, Tony
Lloyd, Sir Ian (Havant)


Fearn, Ronald
Lloyd, Peter (Fareham)


Field, Frank (Birkenhead)
Lofthouse, Geoffrey


Flynn, Paul
Lord, Michael


Fookes, Miss Janet
McCrindle, Robert


Forsyth, Michael (Stirling)
Macdonald, Calum A.


Forth, Eric
Macfarlane, Sir Neil


Foster, Derek
McKay, Allen (Barnsley West)


Fowler, Rt Hon Norman
MacKay, Andrew (E Berkshire)


Fox, Sir Marcus
Maclean, David


Franks, Cecil
Maclennan, Robert


Freeman, Roger
McLoughlin, Patrick


Fry, Peter
McNair-Wilson, M. (Newbury)


Galbraith, Sam
McNair-Wilson, P. (New Forest)


Gale, Roger
Madel, David


Garel-Jones, Tristan
Mans, Keith


Gilbert, Rt Hon Dr John
Maples, John


Gill, Christopher
Marlow, Tony


Gilmour, Rt Hon Sir Ian
Martin, David (Portsmouth S)


Glyn, Dr Alan
Martin, Michael J. (Springbum)


Golding, Mrs Llin
Mates, Michael


Goodhart, Sir Philip
Maude, Hon Francis


Goodlad, Alastair
Mawhinney, Dr Brian


Goodson-Wickes, Dr Charles
Maxwell-Hyslop, Robin


Gorst, John
Meyer, Sir Anthony


Gow, Ian
Mitchell, Andrew (Gedling)


Gower, Sir Raymond
Molyneaux, Rt Hon James


Greenway, Harry (Ealing N)
Monro, Sir Hector


Greenway, John (Ryedale)
Moonie, Dr Lewis


Grylls, Michael
Moore, Rt Hon John


Gummer, Rt Hon John Selwyn
Morris, M (N'hampton S)


Hampson, Dr Keith
Morrison, Hon Sir Charles


Hanley, Jeremy
Moss, Malcolm


Hannam, John
Neale, Gerrard


Hargreaves, A. (B'ham H'll Gr')
Nelson, Anthony


Hargreaves, Ken (Hyndburn)
Neubert, Michael


Harris, David
Nicholson, David (Taunton)


Haselhurst, Alan
Nicholson, Emma (Devon West)


Hayes, Jerry
O'Brien, William


Hayhoe, Rt Hon Sir Barney
Onslow, Rt Hon Cranley


Hayward, Robert
Oppenheim, Phillip


Heathcoat-Amory, David
Owen, Rt Hon Dr David


Heddle, John
Page, Richard


Heseltine, Rt Hon Michael
Paice, James


Hicks, Mrs Maureen (Wolv' NE)
Patten, John (Oxford W)


Hicks, Robert (Cornwall SE)
Pawsey, James


Higgins, Rt Hon Terence L.
Porter, Barry (Wirral S)


Hind, Kenneth
Porter, David (Waveney)


Hogg, Hon Douglas (Gr'th'm)
Portillo, Michael






Powell, William (Corby)
Sumberg, David


Price, Sir David
Summerson, Hugo


Radice, Giles
Tapsell, Sir Peter


Rathbone, Tim
Taylor, Ian (Esher)


Redwood, John
Taylor, John M (Solihull)


Rhodes James, Robert
Taylor, Matthew (Truro)


Riddick, Graham
Taylor, Teddy (S'end E)


Rifkind, Rt Hon Malcolm
Tebbit, Rt Hon Norman


Robertson, George
Temple-Morris, Peter


Roe, Mrs Marion
Thompson, D. (Calder Valley)


Rooker, Jeff
Thurnham, Peter


Rossi, Sir Hugh
Townsend, Cyril D. (B'heath)


Rost, Peter
Tredinnick, David


Rowe, Andrew
Trotter, Neville


Ryder, Richard
Vaughan, Sir Gerard


Sackville, Hon Tom
Waddington, Rt Hon David


Scott, Nicholas
Wakeham, Rt Hon John


Shaw, David (Dover)
Walden, George


Shaw, Sir Giles (Pudsey)
Walker, Bill (T'side North)


Shaw, Sir Michael (Scarb')
Wallace, James


Sheldon, Rt Hon Robert
Walters, Dennis


Shephard, Mrs G. (Norfolk SW)
Ward, John


Sims, Roger
Warren, Kenneth


Skeet, Sir Trevor
Wheeler, John


Smith, Sir Dudley (Warwick)
Whitney, Ray


Smith, Tim (Beaconsfield)
Widdecombe, Ann


Soames, Hon Nicholas
Wiggin, Jerry


Speller, Tony
Wilshire, David


Spicer, Sir Jim (Dorset W)
Winterton, Mrs Ann


Squire, Robin
Winterton, Nicholas


Stanbrook, Ivor
Wolfson, Mark


Steel, Rt Hon David
Wood, Timothy


Steen, Anthony
Yeo, Tim


Stern, Michael



Stevens, Lewis
Tellers for the Ayes:


Stewart, Allan (Eastwood)
Mr. Alan Howarth and


Stokes, John
Mr. Stephen Dorrell.




NOES


Abbott, Ms Diane
Mahon, Mrs Alice


Barnes, Harry (Derbyshire NE)
Michie, Bill (Sheffield Heeley)


Benn, Rt Hon Tony
Morley, Elliott


Bermingham, Gerald
Nellist, Dave


Bidwell, Sydney
Parry, Robert


Campbell, Ron (Blyth Valley)
Patchett, Terry


Canavan, Dennis
Redmond, Martin


Clay, Bob
Salmond, Alex


Cohen, Harry
Sedgemore, Brian


Ewing, Mrs Margaret (Moray)
Skinner, Dennis


Fields, Terry (L'pool B G'n)
Thomas, Dr Dafydd Elis


Grant, Bernie (Tottenham)
Vaz, Keith


Heffer, Eric S.
Wall, Pat


Hinchliffe, David
Welsh, Andrew (Angus E)


Lewis, Terry



Livingstone, Ken
Tellers for the Noes:


Loyden, Eddie
Mr. John Hughes and


Madden, Max
Mr. Jeremy Corbyn.

Question accordingly agreed to.

Ordered,
That Mr. Dave Nellist be suspended from the service of the House.

Mr. Speaker: then directed the hon. Member to withdraw from the House.

Mr. Nellist: I shall be back.

Mr. Ivan Lawrence: On a point of order, Mr. Speaker—[Interruption.]

Mr. Speaker: Order. Will the hon. Member for Coventry, South-East kindly withdraw?

The hon. Member then withdrew.

Mr. Speaker: The interruption has taken time out of a Standing Order No. 20 debate that I granted yesterday, of great interest to the whole House. I ask the House now to allow the debate to proceed in good order so that as many hon. Members as possible may participate.

Mr. Lawrence: On a point of order, Mr. Speaker. Your kindness and generosity are well known, but the fact is that the whole House heard the hon. Member for Sunderland, North (Mr. Clay) call you a "Tory stooge". He did not do it once or twice accidentally. He made absolutely sure that everybody in the House heard that attack, not only on you, but on the great office that you hold. It was a deliberate attempt to undermine your authority and must be looked upon with disgust by all hon. Members, from whichever party they come.

Mr. Speaker: I did not hear that comment. The mere fact that we are having a Standing Order No. 20 debate clearly refutes what the hon. Gentleman is alleged to have said.

Mr. Eric Forth: rose—

Mr. Tony Marlow: rose—

Mr. Speaker: Order. This is an opportunity for the House to obtain information from the Secretary of State for Social Services on a matter which is of great interest to the House and the country. did not hear the comment and do not propose to take any further points of order on it. Mr. Moore.

Mr. Moore: So far as the results of the estimates published by the Government are concerned, there is no secret that both sets of tables show that some are now better off, some in much the same position and some less well off following the changes. Overall, the results show that around 77 per cent. of couples with children, 60 per cent. of lone parents, and 81 per cent. of sick and disabled people are unaffected or are better off in structural terms as a result of the reforms. These are valuable improvements which will be widely welcomed. Overall, around three fifths, or 57 per cent., will be better off, or in the same position, simply on this structural—

Mr. Alex Carlile: I hesitate to interrupt, because I very much want to hear what the right hon. Gentleman is saying, but even those of us who have good and sharp hearing cannot hear what he is saying because he is speaking too quietly. Will he please be kind enough to speak up?

Mr. Speaker: Order. I understand that the Secretary of State has an infection. I have done my best to help by having the microphones turned up to the fullest extent. I f the House listens in silence to what the right hon. Gentleman has to say, that will be greatly to the benefit of the House and will assist the Secretary of State.

Mr. Moore: Thank you, Mr. Speaker.
Overall, around three fifths, or 57 per cent., will be better off or in the same position, simply on this structural comparison, ignoring the effects of the transitional protection. That was the point that the hon. Member for Livingston rightly addressed.
Turning to the actual cash position, which real people actually experience this month, the published tables show that about 92 per cent. of couples with children, 89 per cent of lone parents, 87 per cent of pensioners and no less than 98 per cent. of sick and disabled people are either better off or no worse off in cash terms. In total, 88 per cent. of those receiving income-related benefits are in that position. Of course I recognise that hon. Members are concerned about


individual cases and about those who may be less well off, but I hope that the figures help to put their position into context.
Before leaving this general area, let me say a few words about one particular change which I know has caused some concern to some of my hon. Friends—the change in the treatment of capital.
Let me emphasise that one of our prime aims is to focus help on those groups most in need. Until last week, one could be in receipt of housing benefit with £25,000 sitting in a current account. That simply did not make sense. It is entirely reasonable to ask people with substantial resources of their own to use such resources before turning to help from public funds. In comparison to the old system—

Mrs. Mahon: rose—

Mr. Moore: Perhaps I could explain the point about housing benefit. In comparison to the old system, the new rule is in fact very beneficial to those most in need and to those with small savings. Hitherto, those in greatest need were ineligible for any help through supplementary benefit if they had only £3,000 in capital. That limit is now doubled to £6,000. In housing benefit—like income support and family credit—we will now be completely ignoring the first £3,000 of capital—again benefiting those with only modest resources.
We have felt it both right and fair to expect those with more significant resources, particularly over £6,000, to look to those resources in the first place rather than to taxpayers, some of whom—

Mrs. Mahon: rose—

Mr. Moore: If I can complete the whole point, I shall be happy to give way to the hon. Lady.
We have felt it both right and fair to expect those with more significant resources, particularly over £6,000, to look to those resources in the first place rather than to taxpayers, some of whom may have fewer resources than themselves, for extra help. Let us be perfectly clear. Housing benefit, like all the income-related benefits, is for people who have little money of their own. That means testing both what they earn and what they own by way of capital. The only difference between housing benefit and income support is that one is for housing costs, the other for living costs in general. They are both paid for by taxpayers. Recognising the similarity between the two benefits, we now have the same test of capital for all the income-related benefits.
Some of my hon. Friends want to see a higher capital limit, but do they really believe that we should pay basic maintenance benefits to people with, for example, £10,000 in the bank? After all, one purpose of saving and thrift is to enable one to look after one's own needs rather than depend on other taxpayers. We have therefore struck a careful balance between the need to ensure that money goes only to those who really need it, and the need not to penalise thrift. It is, incidentally, ridiculous for the Opposition to talk about this Government penalizing thrift. Under the last Labour Administration, pensioners saw the value of their savings destroyed through inflation. Pensioners' income from savings fell in value by 16 per

cent. under Labour, but increased in value by 52 per cent. in our first six years alone. I happily give way to the hon. Lady.

Mrs. Mahon: May I draw the Secretary of State's attention to a case that was brought to me this morning? [Interruption.] The point that I want to raise relates to the £6,000 cut-off limit.
The case relates to a woman in my constituency whose house is up for sale. She is 59 years old and draws £35 per week supplementary benefit. She has lost the whole of her benefit because she is deemed to have a capital asset. The house has been valued at £14,000. She has been trying to sell it for 12 months, but cannot. Will the Secretary of State tell us what transitional arrangements have been made for Mrs. Richardson and the two other people who contacted me this morning, one of whom has threatened suicide?

Mr. Moore: She can, of course—

Mrs. Mahon: She cannot get a loan.

Mr. Moore: Obviously, I shall ask my hon. Friends to look at the detail. She can, of course, obtain a commercial loan with regard to the sale.

Mrs. Mahon: She cannot make the repayments.

Mr. Moore: There is difficulty in trying to answer any individual case, but the fact is that a person could, in general, take a loan on the capital value whether or not she has income—[Interruption.] I will obviously, as the hon. Lady—

Mrs. Mahon: On a point of order, Mr. Speaker.

Mr. Speaker: Order. I cannot see how a point of order arises.

Mrs. Mahon: rose—

Mr. Speaker: Order. I advise the hon. Lady that she is doing her colleagues a grave disservice because she, too, wrote to ask if she could participate in the debate.

Mrs. Mahon: rose—

Mr. Speaker: If it is a point of order that I can answer, I shall have to take it. I hope that it is.

Mrs. Mahon: I believe that the Secretary of State is deliberately misleading the House—[Interruption.]

Mr. Speaker: Order. The hon. Lady may not have been here very long, but she must know that that comment must be withdrawn immediately.

Mrs. Mahon: I am sorry if I was accidentally insulting the Secretary of State, but what he said was not true.

Mr. Speaker: Order. The hon. Lady may have disagreed, but will she please withdraw the words, "deliberately misleading"?

Mrs. Mahon: Yes, of course. I do so quite willingly. But I have a point of order, Mr. Speaker. My point is that people without income cannot get loans. I do not think that the Secretary of State understands that.

Mr. Speaker: That is not a point of order for me.

Mr. Moore: I was trying to make the general point that is applicable in this kind of case, but I cannot comment on


the individual case. If an asset is up for sale, it is possible to have a collateralised loan on it. I shall not pursue the point, but I ask the hon. Lady to let my junior Ministers have the details and we will pursue it.

Sir Peter Emery: While no one would expect that someone with £25,000 in the bank, as my right hon. Friend has suggested, should be given help, the aspect of targeting, which is part of what has happened, shows that there may be a problem at the £6,000 level. Will my right hon. Friend confirm that the level need not be immutable but could be adjusted at any time that the Government wished?

Mr. Moore: My hon. Friend is right about the statutory position.
There is one final misconception. The reforms are not about cuts. Quite the contrary: social security spending is already at record levels—far higher in real terms than under Labour. And we will be spending an extra £2 billion this year compared to last, taking the benefit budget to £46 billion, or around a third of total taxpayer expenditure. Even after allowing for the effects of the annual uprating of benefits, we are spending more on social security this year than last.
I recognise that no major change, even to a system as badly in need of reform as this one, can be easy or wholly painless, but the difficulties in making the actual transition cannot be allowed to preserve an unsatisfactory system for ever. This Government—unlike their predecessors have—had the courage to tackle the real and fundamental problems with the old structure. We have produced a benefits system which is simpler, better targeted on priority groups and which enhances rather than obstructs individual responsibility and choice. It is a charter for self-respect and directs more help to those who need it most. It is the right approach.

Several Hon. Members: rose—

Mr. Speaker: Order. In view of the time which has been lost in the debate, I again make an appeal for brief contributions.

Dr. David Owen: The social security shambles over which the Secretary of State presides may or may not provide the political banana skin on which the Government will slide, but it has certainly put the skids under the Secretary of State personally. No one could have listened to his speech without realising the discomfiture behind it. As the House well knows, the reason is that the Government forecast, that there are only 12 per cent. losers, defies the experience of hon. Members in their constituencies in every part of the country. Everyone knows that there has been a serious miscalculation.
On housing benefit, there is a general feeling that because rents are so different throughout the country it is appropriate that there should be a different capital limit and that £6,000 is much too low. There is no sign that the Government are prepared to think again on that. Apart from that, we have concrete evidence that the impact is extremely harsh on people where there is no question of cash but only an income assessment. An elderly widow on retirement pension, who is receiving her husband's Civil

Service pension, was getting £54·30 a week. Her housing benefit was £28·25 per week. That has been cut to £17·04, leaving her to pay £22·72 . She has to manage on £31·58.
Innumerable nasties have suddenly appeared. It is all very well for the Secretary of State to talk about the hours of debate, but how many people have realised that prior to 11 April there was discretion to disregard totally a war pension when assessing a client's need but that it is now statutory that only £5 is disregarded? Citizens advice bureaux are reporting to us that this can mean the loss of up to £30 per week, although the average loss is about £10.
Wherever we look, we find hardship. The debate is about whether the Secretary of State and the Government are prepared to indicate that they will use the power of regulation and of advice to social security offices to introduce an element of discretion to alleviate the harshness of the impact on individual families. We have not had one sign that the Government are prepared to think again. If it transpires, as is widely felt, that there has been a serious underestimate of the number of losers and that the heart-rending cases which are coming up in constituency after constituency are real, will the Secretary of State follow the example of the Minister of State in relation to the disabled? The Minister of State discovered that some people would be really hard hit, and he introduced a fund. We may argue about the fund but at least there was an alleviation and a genuine attempt to deal with the problems of the disabled.
I am glad to see the former Secretary of State for Social Services on the Front Bench. It is widely reported that he anticipated the problem with the capital amount and asked for a £10,000 capital amount. It is widely reported that the amount of the grant that the Government's advisory committee wanted was four times as much.

The Secretary of State for Employment (Mr. Norman Fowler): The right hon. Gentleman has mentioned me. He talks about what has been widely reported. His statement is inaccurate. My view on the £6,000 capital limit was set out in the Green Paper. That capital limit applies not just to housing benefit, but, as my right hon. Friend the Secretary of State has just made clear, to supplementary benefit and to income support as well. If the right hon. Member for Plymouth, Devonport (Dr. Owen) feels so strongly about that, perhaps he will explain why the Government of which he was a member did nothing to extend the capital rule and had a wicked cut-off at £1,200, with a total cliff-edge effect.

Dr. Owen: I was giving the right hon. Gentleman more credit than appears to be due to him. Of course, The Independent in its editorial also gave credit to him, and it will no doubt wish to change its view. [HON. MEMBERS: "Answer."] If the right hon. Gentleman says that in Cabinet he argued for a £6,000 limit, I accept that. But the basic point is still the same. That is an inadequate limit. The hardship that is being imposed on the housing account is considerable. The example which I gave represents a case which has nothing to do with capital, and I could cite other examples.

Mr. Fowler: rose—

Dr. Owen: I will not give way again.
What about the social fund? We now hear from Islington borough that it is being recalculated. In 1986–87, Islington borough was paying out about £4·5 million in


single payments. The same offices in Islington have been given for social fund grants for 1988–89 a miserly £811,351—more than an 80 per cent. cut. Why? Because for the 32 weeks which were the basis for the calculation of the assessment, there was a shortage of staff and problems in the social security offices which were therefore paying out much less in discretionary grants. That is another indication of the arbitrary way in which the social fund has been calculated. Clearly a mistake has been made in Islington. It will have to be rectified and that will call in question the cash limits on the social fund.
Again, we ask the Government to indicate that they are prepared to use the contingency fund of £5 billion to make an alleviation on the social fund. People have repeatedly warned the Government throughout the hours of discussion that the cash limit on the social fund is grossly unfair and that there must be an alleviation. It is an unrealistic cash limit and it will have to be changed. Again, there must be flexibility.
There should also be flexibility in community care grants. They comprise the one element in respect of which people do not have to repay the grant that they are getting. There is an exceptional provision. It relates to the social fund guidance that goes to social security offices. Again, will it be possible to look at the guidance that goes to social security offices? When faced by such clearly exceptional cases, will they be able to use the community care grant rather wider than just to prevent people going into institutional care to alleviate their financial circumstances? Otherwise, there will be no way of helping such people.
Again, citizens advice bureaux record the fact that no charitable funds are available to alleviate hardship in individual cases. The debate—this is why, presumably, in your wisdom, Mr. Speaker, you chose to give the House this debate so urgently—is about the possibility of making regulations and introducing changes in the advice to social security offices that will alter the situation. That is what we urge. That is why the indignation that has been expressed needs to be taken seriously by the Government. They can tough it out; they can ignore it and say that it is a U-turn.
In fairness, parts of the legislation are welcome and long overdue, particularly on the unemployment trap, which has been overcome, and the new credit for families. But, because the restructuring of the legislation was unable to inject extra money to float off anomalies and hardship, the legislation, the Government and the Secretary of State are in danger of being discredited. We do not worry about their reputations, but we worry about individual cases. On their behalf, there is a wish in the House that the Government should think again.

Mr. Roger Sims: The debate has been mounted by the Opposition as an opportunity to criticise the Government for introducing changes to the social security system. We should take this opportunity to give credit to my right hon. and hon. Friends for tackling the social security confusion that has existed for so long. I include my right hon. Friend the Secretary of State for Employment and my right hon. Friend the Chief Secretary to the Treasury, both of whom did a great deal of groundwork on the matter.
Surely there is no dispute in the House that, as it existed, the previous system was almost impossible for claimants to understand. It was complex, difficult to administer, and uneven in its effect. It bristled with anomalies. We have heard how people were getting housing benefit, despite having substantial capital. It had reached the point at which one in three households was drawing housing benefit. There were cases in which people on supplementary benefit were better off than those who were receiving low wages. Of course, if they had got a job, they would have lost such benefits. That was a disincentive to try to find a job. There have been cases of families claiming single payments for items for which other families on modest incomes had to pay and budget for. That was expenditure not of Government money but of taxpayers' money. Taxpayers' money—often from people on small incomes—was deliberately redistributed.
The Government were right to review and to recast the system. It is now simpler, easier to administer and understand, and it is constructed to direct help where it is most needed. It is aimed especially at poorer families with children.
I confess that I am at a loss to understand how a system with such qualities can be described as wicked, iniquitous or unchristian by certain bishops who do not appear to have studied the details of the schemes. Of course, the problem is that, in order to administer any system of this sort, we need regulations and guidelines that are necessarily drawn up by civil servants and approved by Parliament to seek to cover every situation and every possible combination of circumstances.
Because human beings' situations differ, anomalies and omissions may appear as the scheme operates. If that is so, I am quite sure that Ministers will learn from experience. If there is a case for changes on the margins, Ministers will not be dilatory in making them. If such changes involve regulations requiring parliamentary approval, so be it

Mr. Nicholas Winterton: rose—

Ms. Joan Ruddock: rose—

Mr. Sims: Bearing in mind what Mr. Speaker has said, I prefer to keep my remarks as brief as possible and to give hon. Members an opportunity to speak later.
One of the best features of the new system is the social fund. Instead of making single payments according to a rigid formula, it treats each case on its merits. That makes a great deal of sense. One of the many misrepresentations that we have heard from the Opposition is the suggestion that only loans will come from the social fund. It has been made perfectly clear that certain people will qualify for outright grants.
There has been much talk about winners and losers. Of course, if we recast a system, unless the previous system was absolutely faultless—it clearly was not—it is inevitable and indeed right that there will be losers and winners. We have heard what the figures are. Fewer than 1 million people will receive less, the circumstances of about 2 million people will be unchanged, and over 5 million people will be gainers, and gainers of some substance. Yesterday, in reply to a question from me, my right hon. Friend told me that 40 per cent. of gainers will be better off to the extent of £3 a week or more.
There is a philosophical divide. We know that the Labour party favours the mass redistribution of wealth, with benefits being given to all and sundry, regardless of


their means or needs. At the other end of the political spectrum, the old-time Liberals would have endorsed a laissez-faire policy and said that no payment should be made to anybody. We have yet to learn the present Liberal party policy, whatever name it may come under. My right hon. and hon. Friends and I believe that the state should give help, but that it should be directed where it is needed and that it should not be on such a generous scale that people—

Ms. Ruddock: rose—

Mr. Sims: I shall not give way. If the hon. Lady does not mind, I wish to keep my remarks brief.
Help should not be on such a generous scale that recipients make no effort to provide for themselves. There is a real dilemma. Where do we draw the line?
That dilemma is vividly illustrated by the housing benefit controversy. Clearly, someone on a small income and with little or no capital will need and should receive housing help. Similarly, somebody with tens of thousands of pounds is well able to provide for himself. But people who have been putting money aside have done so for their old age. Should they be penalised by not getting benefit because they have put money aside, particularly when they see their neighbours, who have spent money on the good things of life, now qualifying for benefit?
Where do we draw the line? Of course, there is no right answer. Wherever we draw the line, it will be argued that people will be discouraged from being prudent and that, if they are above the line, they will realise that they can spend a little more freely so that they go below the line and enjoy benefit.
With housing benefit and other forms of social security there will always be bad borderline cases. It is right that hon. Members and others should draw attention to them. But it is not right that politicians should use half-truths, distortions and downright misrepresentations to whip up a campaign purely for party advantage, incidentally causing a great deal of unnecessary concern to individuals. The Labour party's campaign does its members no credit. This reform of the social security system will be looked upon as one of the Government's great achievements.

Mr. Frank Field: I wish to make one comment about the previous contribution, as I greatly respect the hon. Member for Chislehurst (Mr. Sims). I think that it is probably fair to say that I agree with the content of his speech about as much as he really does, even though he did a reasonable job of trying to defend the Government's record.
I take issue with the remarks of the right hon. Member for Plymouth, Devonport (Dr. Owen) who, for once, decided to paint a very small picture on the political canvas. He was partially right that this debate is about trying to get the Government to give way and to make some concessions, although, had he taken even more time in his contribution, he might have answered his own question and said that we have very little chance of getting the Government to do that.
To me, this debate represents a watershed in a number of respects. This is the first debate in which I have participated in the House in which the issue of the poor has been of concern to a large number of hon. Members rather than to a few. Yet had we been holding this debate even

only a few decades ago, we should have done so against the background of a link between the interests of the poor and the working class. One of the major factors that we have to take on board as a parliamentary democracy is the problem of how to represent the minority interests of the poor, which are clearly different from the interests of many working-class people.
Hon. Members will know that I probably owe my seat to my work for a pressure group representing the interests of poor families. Even with that background, however, I find it difficult to make the leap of imagination required of all of us when we are debating such matters and to contemplate what it is like having to live on the kind of income that will result from the reforms that the Government are introducing this week.
Let me give a couple of examples. For those under the age of 18, we are talking about £2·77a day for everything other than rent. For those aged 18 to 24, we are talking about £3·67 a day, for a married couple—for each individual—from which they must cover all their needs, including the famous holiday that we have heard about, of £3·76. I point the finger not just at Conservative Members, but at myself. It is extremely difficult to contemplate what it is like to experience that standard of living. Yet in this debate we are talking about cutting, not increasing, the number of pennies that people have.
Secondly, this debate represents a watershed because of the feeling that is emerging on the Conservative Benches. I think it was Oscar Wilde—if it was not, I am sure that he would have thought of doing so—who referred to the love that dare not speak its name. There is also on the Tory Benches an unease that dare not voice itself publicly. It is an unease that is founded not just on the fear of lost votes, because many hon. Members have probably rightly reached the conclusion that those who do not like Tory policies have long since ceased voting for the Tory party; it is an unease not just about our stick and carrot society, in which a huge carrot and a massively large stick are used to try to create incentives, although Conservative Members quietly express their concern about that; and it is an unease that stems not just from the fear of disorder on our streets, because Conservative Members know that the riot has been privatised—people go about in ones and twos to do their mugging and robbing—and that we shall not suffer the disorders of the 1930s. It is not even to do with the way in which the Prime Minister bangs on and on—I feel that if I hear any more I shall suffer permanent brain damage—or about her trickle-down theory; and it is some trickle for the constituents whom we are discussing today.
Conservative Members' unease lies not only in all those things, but in something more. Even in Tory seats, and! more so in Labour seats, whole ghettoes are appearing. Visiting them is like travelling back in a time machine and getting out 25 years ago. I see sights in my constituency that I have not seen in London since I was a boy. I see pinched faces, shuffling feet and ill-fitting clothes, which are all the signs of poverty. It is from those people that we are taking money.
That is part of Conservative Members' unease, because many of them react to those sights as we do. They feel a deep unease, either from a secular point of view—they experience a gut reaction that it is not right for a society to be generating such wealth and, cheek by jowl with it, such poverty—or from the straight Christian point of vim that each of us is an equally important part of the creation and


that we should not be denying a large part of our population, albeit a minority, a share in the living standards that most of us can enjoy.
Thirdly, this debate represents a watershed because of the challenge that it poses to the Opposition, in addition to the challenge to Conservative Members to voice their unease. In her letter to the Leader of the Opposition, the Prime Minister chided him for always criticising the Government. That is amazing coming from someone who is so interested in how public money is spent, because the Leader of the Opposition is paid to oppose the Government. That is our job. Imagine what the response would be today if we were not doing our constitutional duty of opposing the Government. That is why I think that we shall carry the debate—in argument, if not in votes later—tonight.
However, if we are to follow up this immediate challenge, we need a vision of the sort of society that we are trying to create. We cannot get down to the fundamental job of recasting the welfare state, the tax system or any other aspect of home policy, unless we know the sort of society in which we wish to live. When we have that map and compass, we can get on with the task and with the second stage of opposition, which involves holding up an alternative vision to replacing rich ghettoes for the majority and increasing pauperisation for a large minority of our citizens.
While that task is underway, we are perfectly in order to carry out our duty by drawing the attention of the House and the country to social security reforms that take money away from people who are asked to live on £2.77 a day, £3.67 a day or, for the ultra-rich among the poor, £3.76 a day. That is what this debate is partly about, but I hope that I have convinced the right hon. Member for Devonport, at least, that it represents a watershed in many other ways as well.

Mr. Robert McCrindle: The hon. Member for Birkenhead (Mr. Field) will be aware that I have, indeed, expressed some unease over the past few days about some aspects of the social security changes. I propose to repeat some of those expressions of unease this evening. I hope that my colleagues on both the Back and the Front Benches will concede that, in my case, we are not talking about the expression of an unease that has suddenly come upon me. It is something to which I have drawn the attention of successive Ministers at the Department of Health and Social Security, and proof of my concern is evident throughout the pages of Hansard from 1986 to the present.
Before I express my unease, I feel that it would be wrong not to say at the outset that there is much in the reforms that I warmly commend. The Secretary of State was absolutely right to say that the old system was imperfect and full of loopholes and anomalies. There was no more fervent supporter than myself of a move to change that, and to introduce a system which, through such devices as income support and family credit, came closer to targeting those in the greatest need and paying benefits accordingly. I repeat unashamedly that much of what the Government have done is a move in the right direction. Therefore, it is a pity that some aspects of the

housing benefit changes, upon which I shall concentrate, seem to be far too harsh and will hurt people because of the sharp reduction in the standard of living that they impose.
It is central to my argument not that we should ignore the existence of capital, but that the steepness with which we move into and out of entitlement to housing benefit has not been given sufficient attention by the Government. I could say much about housing benefits relating to single people under 25, but I hope that the House will forgive me if I devote the rest of my speech to pensioners. Whether we think that the percentage of losers is 12 per cent. or 43 per cent., no one has sought to deny that a sizeable proportion of the losers will be pensioners whose standard of living will undoubtedly fall as a result of the imposition of these requirements.
In essence, the existence of only two tapers by which housing benefits are reduced on £3,000 capital and eliminated on £6,000 capital is a wholly insufficient way of dealing with an undoubted problem. To reduce housing benefit on savings of £3,000 and to eliminate it on £6,000 is to fail to appreciate the psychology of the generation with which we are dealing. From my experience, that generation sees thrift not just as a practical matter but as something approaching a moral duty. In real terms, £6,000 is a very small nest egg in 1988.
Ministers are wrong to suggest that people accumulate savings so that they can use them as a necessary contribution to a basic standard of living. Elderly people accumulate savings so that they can afford a few luxuries in their later years. By and large, they do not touch the capital because it brings them reassurance and they can rely on the income from those savings. That is why the capital cut-off is so unfair.
I do not disagree in essence with a capital cut-off, because I concede immediately that there must be one. A person receiving old-age pension and a sizeable occupational pension but without savings of any sort is dealt with gently, and many such people will continue to receive housing benefit. However, a pensioner on the old-age pension only and £6,000 in savings is penalised. It is little wonder that such people feel that thrift is being discouraged. The only conclusion that they can reach is that the Government expect such pensioners to use the capital that they have accumulated with great pain and over a long time in order to save the Government money. That cannot be right.
I repeat that there must be a cut-off point. No one would suggest that people with sizeable deposits in a building society—a figure of £25,000 was mentioned—should continue to receive housing benefit. As I have said, the steepness of the cut-off is far too high. For the life of me I cannot see why the Government have concluded that £6,000 is the right figure for an individual and also the right figure for a couple. The Government should say that, although the figure may have to remain at £6,000 for an individual, they will move to £10,000 perhaps for a couple and that the figures should at least be linked to the retail prices index so that we know that they will not remain static. I remind the House that the figure has remained static since the Fowler review of 1985. For that reason alone, there is an argument for saying that the figure should be increased.
I have no doubt that it is very desirable to release people from what the Government choose to call dependence. However, independence will get a bad name if release is


too swift and too harsh. I repeat my call for more than two tapers. That is a simple request and one that I have made during all the developments since the Fowler review. I know that there is no virtue in consistency in politics, but I have been repeating this point for three years. I hope that my colleagues, who may by this time be a little bored listening to it, will forgive me if I repeat it. Many of my hon. Friends share my views and have expressed them to me in private. I hope that sometimes some of them will be a little more vocal in their expressions of discontent.
I recognise that my speech is not calculated to bring the greatest comfort to the Government. I know that what I say is demonstrated by the cases that I have heard in my constituency surgery and by the letters that I have received. I remind Ministers that I should be astonished in the extreme if many of the people who have made these representations did not vote for me in June of last year. There is a political and humanitarian dimension. I know the Minister well and have a great regard for him. I hope that he will take these points on board and recognise that there is real concern, and that, if it cannot be eliminated, it can at least be decreased by a relatively small movement by the Government. Sooner or later the pressure will be such that the Minister will have to concede. Dare I hope that he will start to do so now?

Mr. Thomas Graham: I never thought that I would see a Government attack our poor people. During my 12 years in local government I never thought that I would see a Government concentrate such a vicious assault on the living standards of many ordinary men and women who have fought for this country and done so much to make it great.
I listened the other night to one of the most heart-breaking pleas that I have ever heard. I received a phone call from one of my constituents and when she finished speaking to me I was in tears. The woman has a mentally handicapped son who is suffering from Down's syndrome. Her husband has suffered a massive heart attack and is on invalidity pension. Until recently she was paying £16 in rent and rates, but has now received the bombshell news that she has to pay £105. That is an increase of £89. The woman was absolutely shattered and does not know where she will get an extra £89 to keep her family. That is an enormous and obscene increase for someone in such dire circumstances. Knowing this Government, I could not offer her much hope. However, I have now heard the speech of the hon. Member for Brentwood and Ongar (Mr. McCrindle) and I hope that there are many like him who can give us support.
I heard another hon. Member speak about winners and losers. This must be the most obscene race ever created when we can see winners and losers in a society with millions of people unemployed and millions living on state benefits through no fault of their own. Talk in the House about winners and losers must be stopped. There should be no losers. All people should be able to gain and live a better life.
The social fund has been mentioned. I understand from the social workers of Strathclyde regional council that one of the first refusals has occurred. Social fund help was refused to a single-parent family in which there is a young boy under five years of age who has a heart murmur and an enlarged heart. A room caught fire in the house in which he lives and the bedding and beds were burnt to a

cinder. His mother went to see whether she could obtain a community care grant after being advised by the social work department. Unbelievably, she was turned down.
There is nothing more blatant and open than a room burnt to a cinder. How can that person be denied a bed and bedding? I do not know what the social fund is all about. I understand that the young lady had been considered for a budgeting loan. Yet social workers have looked at her budget and said that her outstanding debt will not allow her to obtain a loan. Therefore, she is destitute. She needs help and the only place from which she can obtain that help is the Government, but the Government have turned their back on her this week.
I have in my hand the saddest letter I have ever received. I will not go into detail because the young lady wishes to remain anonymous. The letter is from an 18-year-old girl whose mother died last year. She has now become the legal guardian of her 14-year-old sister and is looking after her. She has written—

Ms. Joan Walley: On a point of order, Mr. Deputy Speaker. I object strongly to the Government Front Bench laughing and giggling while we hear details of this tragic letter. It deals precisely with the issues involved in this debate.

Mr. Graham: As I have said, the young lady is looking after her 14-year-old sister. She works for the Government in a Civil Service department in a low-paid job. The Government's actions have abolished free school meals and free school milk and her young sister will not be able to receive those things because her elder sister is in work. She does not know what will happen as a result of the new legislation.
That letter was from a young kid who is trying to stand on her own two feet and keep her young family together so that they can face the world and have a better life. The Government are making it more difficult for her as time. goes on.
I have received another letter from a pensioner. The man concerned worked and fought for this country and now receives a miserable pension. He now has to pay double the amount of rent that he paid before. That person does not know what to do.
I have had the sad experience of walking through my constituency and seeing some shops selling yesterday's bread at half price. I have had the sad experience of walking through supermarkets and seeing elderly men and women and disabled people hunting about looking for scraps and out-of-date food. Is that the sort of society into which we are driving our folk? I attended a jumble sale the other night and saw people queueing up to buy old clothes in order to clothe their children. I have seen old women buying bashed tins at half price. Is that the sort of society we want?
One Minister has said that 16 to 17-year-olds need to speak to their parents about the benefit cuts to see whether they can help them; that if their parents cannot help them, they should speak to charities and local authorities; and that, if that does not help, they may be taken into care. I wonder whether the Minister could comment on that statement.
I plead with the Government to bring some sanity, fairness and justice into the system and ensure that people are not driven into the mire. We should stop this talk about winners and losers and allow my constituents to live


with dignity and pride and finish their lives in comfort. They should not be driven to putting a wee bit aside for their coffin. That is an obscenity. Offer us some comfort and throw out the nonsensical social fund. Offer us something that meets the needs of Britain today, not the Britain of Victorian days.

Sir Giles Shaw: I shall be brief in this extremely important debate.
There has been substantial argument about the application of the changes to the people to whom they are directed. The thrust of the Secretary of State's argument and the concept with which the Government are seeking to grapple is to design or redesign a system suitable for the needs that are now apparent within the state. We must start from the premise that we are affording £46 billion per annum for social security provisions. That is a proud record of the Government that no one should seek to deny. We have to decide how best that sum should be spent in a way that is consistent with the obligations of the Government to ensure that social provision reaches those in greatest need.
I want to pay tribute to the courage of my right hon. Friend the Secretary of State and his predecessor in seeking to develop changes in a system that few had the courage to touch. We cannot deal with a fundamental review of the 1944–47 system without making significant changes. It is no use trying to make progress on the one hand without having change on the other. We have to change. The argument before the House tonight is the extent to which the changes make the system unworkable or inappropriate for those who will receive benefits.
No one could fail to be moved by the eloquence of the hon. Member for Birkenhead (Mr. Field) or by the significant contribution made by my hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle). Both have voiced their anxiety that what is happening now will not fulfil the task that has been set before the Government. I have little doubt that my right hon. Friend the Secretary of State and his team will be among those monitoring closely the effectiveness of the changes. I have equally little doubt that a review when the issues have been put to the test is infinitely better than combating figures from various groups on their assessment of a projected element of benefit take-up.

Ms. Ruddock: Will the hon. Gentleman give way?

Sir Giles Shaw: No. I promised to be brief.
My right hon. Friend the Secretary of State is seeking to carry out the radical change in our benefit system that we felt, and continue to feel, was necessary in a way that relieves much of the bureaucratic nightmare of the present system yet in a way that is designed to put £46 billion of taxpayers' money into the hands of those who really need it.

Mr. Brian Wilson: rose—

Sir Giles Shaw: The effectiveness of my right hon. Friend's actions must be viewed in the light of the comments of the hon. Member for Birkenhead and of my hon. Friend the Member for Brentwood and Ongar. Only then can we be sure that the good intentions that are

encapsulated in the policy will be properly and truly delivered. That is why I shall support my right hon. Friend in the Lobby tonight.

6 pm

Ms. Joan Walley: I have received a letter—one of many hundreds that I received when I was first elected—from the Rev. David Watkins, who lives in my constituency. He asked me to ensure that people on low incomes and those who find it difficult to manage are protected. I would not be carrying out my duty as an elected representative if I did not speak in the debate and represented the interests of the people about whom he was talking.
Like my hon. Friend the Member for Renfrew, West and Inverclyde (Mr. Graham), I am concerned by talk about gainers and losers. When I listened to the Secretary of State talking at Question Time yesterday about the facts of the matter, I did not know which way to turn next. What does it matter whether people are losers or gainers? Hon. Members are being contacted by hundreds of people who are telling them that they cannot manage because of these substantial reductions.
I can best demonstrate the problem by referring to a letter from a constituent. She writes:
I wonder if you could speak up in the house of commons … on our behalf. I am a householder. I have an unemployed sister and an old-age pensioner sister. I am on supplementary benefit. I have just received a £1·30p increase and my rates have been increased from paying £57 half yearly to £209 half yearly and water rates £136 yearly. I don't have any savings, so how can they possibly expect people to pay these bills, gas and electric insurances, etc.? I am making myself ill worrying about this as I am sure so many other people are with similar problems. They say we will be better off—how? Why can't they stop living in their own world and see how people really are struggling just to live on the poverty line? We don't smoke, drink and have not had a holiday in 8 years because we couldn't afford it and at Christmas it's heartbreaking to receive gifts and not be able to buy anything back for fear of getting into debt. I know they won't do anything because they just don't care, only for the rich, but at least our views can be known when they say how much better off we are. Thank you.
I make no apology for reading that short note, which sums up most admirably the difficulties facing people.
I have sat through the debate and listened to the lack-lustre performance of the Secretary of State. The fact that so many hon. Members are intervening to speak of individual constituency cases shows that, whatever the Prime Minister may say about the facts, the vast majority of people who are dependent on benefits are worried sick and cannot manage. They want the Prime Minister, the Secretary of State for Social Services and the Under-Secretary of State for Health and Social Security to tell them how they can maintain a decent standard of living on these paltry sums of money.
I do not have any illusions that the Government will give in. The Prime Minister has already said that she does not intend to do anything about the £6,000 per year limit, about which we have heard so much. Perhaps we shall be as successful, as my hon. Friend the Member for Livingston (Mr. Cook) was in obtaining this debate, and get that limit changed slightly.
Such a change will lead only to modifications, but there are many more modifications that the Government could make if they cared. They could take note of the many miners and miners' widows who are being penalised by these new arrangements. They are having to receive


payment in lieu of free coal which previously they received. If the Government cared, there are many ways in which they could make modifications.
I challenge the Government to carry out some proper research and to fund independent research to help citizens, the citizens advice bureau in Stoke-on-Trent, the university of Keele and independent research throughout the country so that in a short time we can obtain information and the facts. We could use that information and those facts to ensure that people who are not living with dignity have an improved standard of living. Failure to do that will bring much more quickly a Labour Government who care and only the Government will pay the price.

Mr. Kenneth Hind: Many of the matters that have been raised in the debate have not, I regret, been raised more forcefully in previous debates. There were adequate opportunities to discuss the matter during debates on the Social Security Act 1986 and the housing benefit regulations.
I take issue with Opposition Members who have referred to this measure as a vicious attack on the poor. We must consider the global position in relation to the resources that are given. In 1978–79, the social security buget was £16·4 billion. Today it is £46·4 billion, which is the largest ever social security budget.

Mr. Nigel Griffiths: Will the hon. Gentleman give way,?

Mr. Hind: I shall not give way, because I am sure that the hon. Gentleman will want to catch Mr. Speaker's eye later.
Under the new system, two fundamental matters must be brought forward and considered carefully. The right hon. Member for Plymouth, Devonport (Dr. Owen) referred to the most important intention of this legislation—to deal with the unemployment trap. In the long term there must be incentives for people to take employment and to seek work. A gap must exist between those receiving benefit and those in work. It must be made worth while to seek a job. The figures for the number of long-term unemployed people show that the largest number of long-term unemployed people are in the south-east, where job vacancies are at the highest level and where opportunities are being offered.
The new system does away with the old, bad anomalies in the previous system. They have been tackled and the unemployment trap is much better controlled than it was in the past.
Social security benefits are a safety net; they are not intended to become a way of life for people. Unfortunately, I have experienced the problems—I am sure that other hon. Members have experienced them—of people being unemployed on a long-term basis who have rounded down their expectations of income to the levels of various unemployment benefits. I recommend that hon. Members go to a job club and talk to people attending on the first day about motivation. They should then return at the end of the week and see the difference. The job club has built up people's expectations and made people believe in themselves and appreciate that matters can be improved.
An edifice has built up in recent years and it has created the unemployment benefit dependent society, which

Labour Governments predominantly built up. If Beveridge were to come back he would not recognise the system that he created in 1944. The system was devised to deal with hardship by what we in Lancashire and Yorkshire call the pan crack. If hon. Members ask people on benefit in Lancashire and Yorkshire what they are living on, they say, "Pan crack, lad." The crack has been filled in and overlaid many times as the system has built up.
We must deal with the unemployment culture, and one of the ways to do so is by this new system.
First, the problem of people who have families with young children was tackled. Where is the incentive for people who are staying at home watching television—[Interruption.] Those people who are sitting at home getting depressed will feel that there is no incentive to go out and do anything. This system targets resources on families with children, who will be better off under this system.
I represent a constituency with high unemployment. Like Opposition Members, I have received distressing letters, but interestingly enough I have not had one letter from families with children to whom the major part of this policy has been directed and who will benefit from it.
I suggest that Opposition Members do not do themselves justice in some of their criticisms. The hon. Member for Livingston (Mr. Cook) referred to two samples—one from the Oxford study, and another from Strathclyde. Those samples are far too small. Anyone who has done any research will realise that 200 is far too small a sample to consider. The Wandsworth sample took into account single payments. Because of that, the reduction in income appears to be much larger.

Dr. Norman A. Godman: rose—

Mrs. Margaret Ewing: rose—

Mr. Hind: I am sure that the hon. Members will get an opportunity to speak.
Only 9 per cent. of those who are eligible for single payments have claimed them.

Dr. Godman: Will the hon. Gentleman give way?

Mr. Hind: No.
We must consider those matters carefully, instead of winding up the anxieties of the public.
I accept that certain vulnerable groups will lose out. Conservative Members have anxieties about housing benefit because in the majority of cases the losers in this system are those in receipt of housing benefit and not from the system in general. Therefore, perhaps my right hon. Friend and his ministerial colleagues will look at that in the long term. I suggest that he does not need primary legislation to deal with it. No doubt he will review the matter in the long term and will take on board some of my hon. Friends' comments.
The hon. Member for Livingston referred to Mrs. Godden and to disabled people. One factor that has not been highlighted by Opposition Members is that special provision has been made for 15,000 severely disabled people. Opposition Members ignore the fact that a trust has been set up and it is likely that many of those people will be in the same position when the matter is sorted out as they are today.
I can recall the occasions on which we debated what is now the Social Security Act. We talked for hours about severely disabled people. My right hon. Friend has made real efforts to deal with the severely disabled and he should be given credit for that and for listening to the comments.
I return to the point on which I started my remarks. Under the budget, £46·4 billion is being spent on social security for the next 12 months—the biggest expenditure ever. In the past 12 months there has been a fall of 500,000 in the number of people unemployed. That is a large number of people who will not now be eligible to claim. We must take into consideration the fact that fewer people will benefit from a larger budget. Opposition Members say, "What do you tell them in Skelmersdale?" In the new town of Skelmersdale, in my constituency, 1,500 people have jobs and consequently will not be claiming from the social fund. I am not suggesting that the system is perfect. Criticisms have been made about the social fund and about housing benefit.

Dr Godman: Will the hon. Gentleman give way on the question of the social fund?

Mr. Hind: Those matters can be dealt with along the way. They need not be subject to primary legislation.
Overall, this is a courageous attempt to tackle a very difficult problem. My hon. Friends have dealt with it well. They have tackled a very difficult problem and they have suggested solutions that, obviously, many people do not like. Let us give it a chance to work, and when we find flaws, let us monitor those flaws and correct them in the long term. It is up to hon. Members on both sides of the House to bring forward cases and argue points. This is a good system that will stand the test of time, and I commend it to my hon. Friends.

Several Hon. Members: rose—

Mr. Speaker: Order. It may be helpful if I say that I understand that the first Front-Bench spokesman will seek to rise at 6.35 pm. In the intervening time, if hon. Members are brief, I shall be able to call more of them.

Mr. Archy Kirkwood: When the hon. Member for Lancashire, West (Mr. Hind) considers what he said this evening he will find on reflection that it will not do him any credit. He started his speech by saying that we should look at the global benefit provisions. I remind him that £25 billion or £26 billion of the £46 billion that he mentioned actually relates to national insurance contributory benefits which cover pensions, widows' benefits, unemployment benefits, industrial injury benefits, family benefits, death grants and maternity allowances under the old system. If he were honest about it he would say that he was concerned only about the £8 billion that covers benefits such as supplementary benefit under the old system and £3·5 billion that relates to housing benefit. It is disingenuous of him to use global figures as if the £46 billion were all going direct to benefit of that kind in the coming year.
Secondly, the hon. Gentleman said that he was surprised that people were suddenly enthusiastic to speak on this subject. I do not think that he served on the Standing Committee which considered the Social Security

Bill in 1986. If he did, he was conspicuous in that he said absolutely nothing on the record. If he was on the Committee he should have taken that opportunity to unburden himself at that time.

Mr. Hind: Will the hon. Gentleman give way?

Mr. Kirkwood: I shall not give way to the hon. Gentleman. He has made his own speech and he can reflect on it later.
As an hon. Member who tried to take an active part in that Committee, I found it very difficult indeed to make any sense of the primary legislation. The primary legislation contained no detailed figures of what is happening to claimants now that all the rates of benefits and rebates are available. Nor did the primary legislation say anything about the detail that would be given in the statutory instruments or the guidance given to social fund officers that followed from the primary legislation. That made it almost impossible for hon. Members on that Standing Committee to make any real judgments about the full and dramatic effects of the legislation on individuals when the scheme was implemented.
I can give the House a brief example of that. The Social Security Act 1986 states that social fund officers must "have regard" to the budget in coming to their decisions—that is to say, the budget of their own integrated local DHSS offices. The recently published guidelines, however, contain a different version of the phrase "have regard". They state that an officer must
under no circumstances make an award resulting in overspending against the local office's budget.
That is entirely different in tone and interpretation from the discussions that we had in Committee. During the Committee stage it was therefore very difficult to make any sense of what was actually to happen.
It is wrong to suggest that hon. Members could have made those detailed points before now. I agree with the hon. Member for Birkenhead (Mr. Field) who said that this was a watershed debate. It is a watershed debate because hon. Members are being forced to pay regard to the changes because they are now beginning to hit them where it hurts—in their constituency clinics and in the constituency work that they undertake.
The hon. Member for Pudsey (Sir G. Shaw) said that he was confident that the Government would monitor the effects of the new system. I have serious doubts about whether they will. If, at the end of the debate, the Minister is able to say that he will monitor month by month the effect of the reforms, I shall be slightly happier.

Mrs. Margaret Ewing: Does the hon. Gentleman agree that it is the responsibility of every hon. Member to ensure that Department of Health and Social Security Ministers are inundated with every constituency case that is put to us?

Mr. Kirkwood: I agree entirely with the hon. Lady. No other course is open to hon. Members. The hon. Lady has given sound advice and I, for one, shall take it.
It cannot be disputed that housing benefit will be reduced by £650 million. Of the £420 million that has been allocated to income support, £200 million will only be to cover transitional support. The hon. Member for Lancashire, West said that those losing housing benefit will suffer the most. However, when the transitional income support protection wears away, he will only then realise the true, full impact of these income support cuts.


There will not therefore in reality be an additional £420 million for income support. I accept that there is to be an increase of £200 million in the budget for family credit, but it takes no account of the £120 million that has already been saved by recently freezing child benefit. It takes no account, either, of the take-up rate. The Government's target is a 60 per cent. rate of take-up as opposed to a 50 per cent. take-up rate for the existing family income supplement.
The Government spent huge sums of money on advertising shares in privatisations such as British Telecom and BP. Instead of engaging in fancy privatisation advertising, they should have advertised on television what is available under the social security system. It is a scandal and a disgrace that the savings that these reforms will make for the Treasury are between £300 million and £600 million. If Conservative Members do not recognise that fact now, they will recognise it in a year's time when individual constituency cases start to hit them in their surgeries and correspondence.
The social fund budget for next year is just over £200 million. The Government make as much as they can out of that, but the real figure that is allocated for social fund grants is only £60 million. That expenditure has to be contrasted with the single payments budget for the last financial year, which totalled £190 million. That highlights the swingeing nature of the cuts in the social fund.
The way in which the community care grants will be applied in practice is a great disappointment to me. The Green Paper stated that community care grants would be made to avert the need for institutional care for frail, elderly claimants. There is no way in which the £30 single one-off payments can begin to provide care in the community for such people. The social fund guidelines, in their full and collective glory, that are now being sent to social fund officers make that fact very clear. I am very disappointed that the opportunity has not been taken to make institutionalised care a thing of the past and real and effective care a thing of the future.
As for the way in which pensioners are to be treated, the speech of the hon. Member for Brentwood and Ongar (Mr. McCrindle) will repay careful study. The way that this Government have treated pensioners in general is a scandal. They should take the advice of their own Social Security Advisory Committee and every so often increase pensions above the figure that is justified by increases in the retail prices index. If the Government are not prepared to take the advice of the Social Security Advisory Committee, what advice are they prepared to take? The Government have carried out no research and there has been no proper consultation. The way in which the Government have handled the reform is a disgrace and they deserve to reap their reward at the hands of the public at the next general election.

Mr. Jonathan Aitken: The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) was right to stress the importance of monitoring the developments of the new arrangements. The unease that has been expressed in many speeches on both sides of the House may to some extent be alleviated if the monitoring is close and if certain changes are made in the months to come. There will be many opportunities for that to happen

because the regulations are governed by secondary legislation. If they were so minded, the Government could put changes into effect fairly quickly.
In his speech my right hon. Friend the Secretary of State seemed to express surprise that an emergency debate was necessary, as the matter had been debated so thoroughly and at great length in the past. That is a perfectly fair point, but the position has changed in the last few days. There is a feeling of emergency in the DHSS office in my constituency. The telephone lines are jammed almost permanently and large queues are spilling out into the street. The beleaguered staff inside have only two copies of the income support adjudication guide. It is being passed around 120 officials who are struggling to answer the often emotional and sometimes hysterical queries from pensioners and other claimants. I am glad that from these Benches my hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle) sounded a note of unease that ought to be answered in the winding-up speech. It is right that the Government should be aware of such anxieties.
What is going on in Ramsgate, the biggest DHSS office in south-east England, with 16,000 claimants, is going on in DHSS offices up and down the country. All major reforms face start-up problems. At the beginning they are bound to create difficulties for some people. The question we have to ask ourselves is whether these are just teething troubles or whether there is something radically wrong with the reforms that have been put in place. We have to return to the first principles that lie behind the reforms.
I do not disagree that the supplementary benefit arrangements were far too complicated and needed to be simplified. Moreover, benefits for all are the enemy of care for the few. We need better targeting to give most help to those who are most in distress. The Government are increasing expenditure on social security benefits. Next year they will total £48 billion, which is 13 per cent. of gross domestic product. It cannot be right to attack the Government for stinginess or meanness when they have introduced the reforms that these principles seek to enshrine.
The reforms are right in principle but they are flawed in practice. There are three major flaws. The first flaw is the £6,000 housing benefit cut-off point. I agree with my hon. Friend the Member for Brentwood and Ongar that this figure is too low. My hon. Friend the Member for Thanet, North (Mr. Gale) and I represent one of the largest concentrations of pensioners with slender means in the south-east of England. They live on the margin; their life is not easy.
My hon. Friend the Member for Brentwood and Ongar referred to the fact that pensioners plan ahead in order to live in accordance with their means. They take into account the housing benefit that they already receive. If their standard of living is to be somewhat derailed by this arbitrary cut-off point—fixed, incidentally, without any relationship to income—it is bound to cause widespread distress and anxiety. There has to be a cut-off point, but what that is has to be a matter of judgment.
I agree that the cut-off point should be £10,000. Alternatively, let us have a sliding scale starting at the £6,000 cut-off point and going up slowly to a £10,000 cut-off point. I feel that the guillotine suddenness of total decapitation of housing benefit at £6,000 of savings is wrong. Unless my right hon. Friend the Secretary of State


wants to go down in history as the Robespierre of housing benefit for hard-up pensioners, I urge him to find a higher—and gentler—limit as soon as possible.
There is also the plight of the unemployed, striving to clamber back into employment through part-time work. They are being clobbered by the new rules: they can keep only the first £5 a week of their earnings before losing £1 in benefit for every pound that they earn. That level needs some adjustment.
A constituent of mine, Mrs. Fiona Thomas of Broadstairs, wrote me a moving letter. As a one-parent family, she is therefore given a £15 rather than a £5 limit. She writes:
I have taken the step of trying to help myself by getting a part time job in a chemists. I now work twenty-hours a week, come home tired out, and all I can keep of my wages is £15 and all expenses like childminder and bus fares also have to come out of that £15. Before income support one could claim expenses back. Is it really worth trying to work?
I think that the answer, at present, must be no.
Anyone with a high-unemployment constituency knows that part-time work is often the best ladder back into full-time work, and I believe that we should help people to get back on to that ladder—back into the habit of work—back to a place where they can grab vacancies in full-time jobs. Part-time jobs are today's socio-economic trend, and we need to encourage rather than discourage those who climb the ladder.
It is not clear whether the teething troubles to which I have referred will last. It all depends on the Government's responsiveness to criticism. It is easy for them to move by secondary legislation, in the Chancellor's Autumn Statement, or even sooner. We need some fine tuning, and perhaps some fine rethinking. I hope to hear some encouraging words in the winding-up speech before I decide how I shall vote tonight.

Mr. Bill Michie: I shall respect your request, Mr. Speaker, to sit down in four minutes' time to enable the Minister to make his winding-up speech. First, however, let me say one or two things very quickly.
I cannot understand some of the Government's arguments about the Opposition using lies to make party political points or to advance propaganda. During the last week, while I have been in my constituency, I have not been sitting there with old people—or young people—listening to lies. I have been listening to the truth. I have heard exactly what is happening to them, as from the beginning of April.
I find it deplorable that we are being accused of using this debate for party-political propaganda. The fact is that literally thousands of our people who have not been well off all their lives are now finding it impossible to meet their bills and demands. To sit between old people on a Sunday afternoon and try to placate them and allay their worries is difficult enough in most circumstances. But now I cannot even say, "Do not worry—we will work something out," because injustice is built into the legislation.
There is no doubt about the problems of, for example, an old-age pensioner living alone. Last night at 9.50 pm, before the vote, I received a telephone call asking, "Where shall I find £87 to pay my rates? I have to pay one fifth of the charge." There is no way in which that person can find

the money. No longer can I say, "I will certainly go for an appeal. I will try to help you out, and argue the case." All that has been taken away from Members of the House—and, of course, from social workers and any other body trying to help.
I ask the Government to listen to the pleas that are being made. For goodness' sake, let us take the party-political blinkers from the Government's eyes so that they can see the suffering, pain and anxiety that they are inflicting on many people who deserve a darn sight better. That is all we ask.
I have had more telephone calls. Only today, at about 6.30, I attended to another. I was asked to request the Government to monitor and review the position genuinely in the future, and I ask the Minister now whether the Government will do that. I do not know whether they can. I am not sure how we shall know how many people have been refused in DHSS offices, and then go home and live with the misery—or go to their families, who are already under pressure with their mortgages and children. We shall never know the full figure.
However, I make this plea: will the Government please monitor the position honestly and sincerely, take away their present political prejudice and come back to the House in six months, so that we can have another debate? Then we can produce not one, not two, but hundreds of cases to prove that the legislation is causing unnecessary suffering to all concerned.

Mrs. Margaret Beckett: When the Secretary of State opened the debate he made two revealing remarks that he may live to regret. First, he made a point of telling us that the proposals had been fully debated, thrashed out and explained over the past three years—years in which his predecessors and he have ridiculed and ignored all representations about the damaging net effects of their proposed legislation. What the Secretary of State was telling us, and what should be clearly set on the record today, is that the Government have made no mistake in what they are doing. They knew what would happen to the individuals and families whom we have discussed, and they chose to proceed.
The second thing that the Secretary of State said was that under the old system people had been locked into dependency, not liberated. One million of those whom the Government describe as a reduced caseload, who lose all entitlement to housing benefit, should clearly be grateful to the Government for liberating them from dependency. Felicity Godden should be grateful. She has been entirely liberated from the supplementary benefit that she now dependently draws. The way in which her case has been dealt with today and yesterday has been most instructive.
It is entirely true—as the Minister says, the Government have known all along—that the most severely disabled have always stood to be the greatest losers. It is fair to remind the House that the Government, knowing that, resisted to the last ditch—until they lost a vote in the other place—all demands to bridge the gap between what the severely disabled receive today and what they will be entitled to receive from this week. Finally, having lost that vote, they introduced a very limited premium for some of the severely disabled, but still with many losers remaining.
Only a few weeks ago, at the last gasp of the legislation, the Government came up with a proposal for the Independent Living Fund, a charitable fund from which


there would be no right to help, and no independent appeal against refusal, but worst of all—at present—no fund. The Government have had three years, yet there are no trustees, no application form and no money. The Department has known for four weeks that Mrs. Godden would lose £48 a week: it told her, after all. Why was she not notified about the fund? Why was she not encouraged to make an application? Where is the information about the interim arrangements for payment that the Minister of State mentioned in passing yesterday, for the first time that I recall inside or outside the House?
All that Mrs. Godden has received from the Government are sneers, abuse and half-truths. Yesterday the Secretary of State said that his offices had not been able to contact her because she had been on holiday, which gave a few of his hon. Friends a good laugh, but Mrs. Godden has been back for 12 days.
The Secretary of State and the Prime Minister talked yesterday about inaccuracies in the story about Mrs. Godden, because they wanted the full list of all the help that she is not losing. Today the Secretary of State spoke about a 19-year-old son who is earning and implied—although he did not actually say it—that he was contributing to the household. He is not. He is only 19. He is a chef, and, as hon. Members on both sides of the House will know, under the Government his wages are so low that he is not able to contribute more than £15 for his own light, washing and heating. He can make no more contribution.
Today also, the Secretary of State said that Mrs. Godden had had a visit from the social services department who offered some domestic help. I understand that the last visit from anyone was on Friday and that some bits and pieces of extra help were offered, but nothing systematic or coherent. The bits and pieces of help included an offer to put the two-year-old child in a nursery, which Mrs. Godden does not want, having herself experienced being in care and not wishing any of her children to have to go into the care of the statutory services. That was the offer that the Secretary of State said was refused.
In all fairness to the Secretary of State, it should again be on the record that at no point did he or the Prime Minister deny that Mrs. Godden is losing £48 a week from this week. Does the Secretary of State deny that now?

Mr. Moore: indicated dissent.

Mrs. Beckett: I see that the right hon. Gentleman shakes his head.
I tell the Secretary of State bluntly that he and the Prime Minister should be ashamed of the way in which the implication has been made in the House that there is something dubious about Mrs. Godden's case. I challenge the Secretary of State and the Prime Minister to go and see Mrs. Godden and explain to her why the changes are a good idea. Mrs. Godden's offence is that she is a living contradiction of the Government's propaganda, which has implied that everybody will somehow be protected. The Government know that she is only one of those for whom no protection is available.
There are others who lose, as Mrs. Godden does, from rule changes, including the war pensioners, quoted by the citizens advice bureaux, who stand to lose on average £10 a week. I understand that the Prime Minister talks a lot about Winston. I wonder what Winston would have had to

say about that. Of course, there are others who lose, as Lilian Williams does, from the levels of benefits now paid. They are all cases that give the lie to the Government's statement that 88 per cent. of people will be no worse off.
Many of those who show up as gainers on the Government's figures will be substantially worse off, because the Government will not look at the net effects of all the changes that are being made. The St. Clairs, referred to by my hon. Friend the Member for Livingston (Mr. Cook), whose figures the hon. Member for St. Ives (Mr. Harris) questioned, confirm that their basic entitlement under income support is indeed £70·05, which is some £18 less than they get today. It remains the case that they have had to give up the idea of moving to more suitable accommodation, because they would lose transitional protection if they did so, and they are trapped in their present situation.
A case was quoted yesterday in the House of someone who will be £1·60 a week better off in cash terms, but worse off by some £12 a week because of the loss of discretionary free school meals. Again, that is someone who shows up as a gainer on the Government's figures. Jim Foley, who, like Felicity Godden, should presumably be grateful to the Government for liberating him from dependency on benefit—he is certainly grateful that he has benefited from having a heart transplant—has had £1·60 added to his invalidity benefit entitlement, but he now loses all opportunity for help with fares. Because he is a heart transplant patient he must return to Papworth hospital at least every four, and sometimes every two weeks. He has to be accompanied because he is a diabetic and because he is so near to the time when he had his transplant. That travel costs him £158 per trip. He will get no help for that now, but under the Government's figures he shows up as a gainer.
The Government ignore not only the direct net effects on the standard of living but the net effects upon society. The young single homeless, who may have taken the advice of the right hon. Member for Chingford (Mr. Tebbit) and got on their bikes to look for work, will he left utterly destitute. There should not be young people wandering the streets alone, but there are, and the strains on poor families as a result of the cuts in benefits that we have been discussing today, particularly the cuts in benefit for the young, will mean that there are likely to he more in future than there are now.
The only accommodation available to such people is bed and breakfast, but in future that accommodation will not be available because benefit will be paid, if at all, in arrears. In London, in particular, young people are likely to need £150 before they reach their first pay day and the landlords of bed-and-breakfast accommodation are not accustomed to waiting for payment and simply will not take people. Of course, such people can apply for a crisis loan, but they are young and single and that means that they have no priority, even if they could be offered one large enough to cover the sort of sum needed.
Will such people have to swell the numbers of those sleeping rough or find other ways of making £150? How long will it be before we find the Home Office once again bewailing the rising crime figures—the rising figures for prostitution or drug offences— because the Government look only at part of the picture, the DHSS savings, and forget the cost in damaged lives?
More and more the Government exemplify the adage—they certainly have done in this debate—that the louder


they talked of their honour, the faster we counted the spoons. The debates on the whole process of the Government's social security changes are an echo of all the debates that we have had on the National Health Service—fancy footwork, fancy figures, fancy words and grim reality for those who are not talking about what the Government are doing, but are living through it.
The fine words that the Secretary of State has uttered about transitional protection and help for the future will lead, most of all, to a hypothetical Felicity Jones, who, later this year, like the real Felicity Godden, is diagnosed as having multiple sclerosis, who finds herself ultimately with the same needs, difficulties and family problems, but who will never get the £48 that Mrs. Godden loses from this week—just one of the millions of future claimants who will be even poorer than those we have discussed today. What is the Government's motto for them? Is it "What you have never had, you never miss"?
The Government claim that they are simplifying the system, but the housing benefit form is now 20 pages, where it was four. They claim that they are targeting help on those in greatest need—a claim which has been shown over and over in the debate to be completely untrue. Most of all, they say that they cannot afford to do any more. That is the greatest untruth of all. It is plainly obvious from what was done in the Budget that the Government's record embodies the other adage, that there is one law for the rich and another for the poor. The Government have cast that in stone as a deliberate choice and a deliberate policy.

The Minister for Social Security and the Disabled (Mr. Nicholas Scott): In a sense, the debate comes at a curious time, and that is no criticism of the Chair. It comes at a time when the broad outlines of the reforms that we are discussing have been known for some years, when the details have been known for some months, and when we have had a series of debates on detailed aspects of the reforms, some in prime time and some after 10 o'clock, where the most outstanding characteristic of those debates has been the Opposition's inability to assemble any strength on the Opposition Benches to talk about these matters. The assembled strength on the Opposition Benches tonight owes rather more to the proximity of the local government elections than it does to their lately found concern for the poor.
Of course, in making that criticism I make no comment about the sustained, intelligent and well-informed campaigns that have been run by the Opposition Front Bench, the hon. Member for Birkenhead (Mr. Field) and a number of others who have maintained their interest in this subject and who have sought to present constructive criticisms of what the Government intend to do. I criticise only some of the behaviour that we have had in the House today.
The debate may be rather late because the details and the broad outlines of the changes have been known for some time. But, in a sense, it is also rather too early because it is difficult for us to assess in detail at this stage the impact of the reforms. We have had a great deal of speculation, much of it ill-informed. A considerable number of individual cases have been brought before the

House with so-called evidence spelt out which, on the facts of the case, are found to be flawed. We should wait to see how the reforms work out in practice.

Ms. Ruddock: Will the hon. Gentleman give way?

Mr. Scott: No, I will not give way. The hon. Member for Derby, South (Mrs. Beckett) and I shortened our speeches to enable as many hon. Members as possible to speak and I should like to get further into my speech before I give way to anybody.
Because of what I have just said about how difficult it is at this point to assess the impact of the changes on classes or individuals, the Government will give a clear and unequivocal undertaking to monitor with great care and sympathy the implementation of the reforms.
I know that we will not be the only people monitoring the impact of the reforms. I imagine that Opposition Members will be doing so too, and I know that academic organisations and welfare rights groups will be monitoring the impact.

Ms. Marjorie Mowlam: Will the Minister give way?

Mr. Scott: No. The hon. Lady knows that I normally give way, but I should like to get on with my speech.
As the reforms bed down and people grow accustomed to their working, we will be carefully monitoring the outcome of the reforms and seeing how they work out in practice. As I have said before, in social security, nothing is for ever. We live in a dynamic society. We need a changing society. There are changing patterns of need in society and obviously, therefore, the need for provision must also change. We shall be monitoring that carefully as the weeks and months go by.
If anyone outside the House had listened to the Opposition's contributions this afternoon, he would have imagined that the reforms were about cuts in public expenditure, imposing some new and, dare I say it, wicked measures on the poor.

Mr. Frank Field: rose—

Mr. Scott: I shall deal in a moment with the serious point raised by the hon. Gentleman. I take his points seriously and with great respect.
Opposition Members have launched a great exercise of hunt the losers. They say, "Scour the country for individuals. Ignore the fact that the Government are putting £2 billion of extra expenditure into social security provision this year. Ignore the fact that, in cash terms, nine people out of 10 will be better off or no worse off after implementation. Forget that £1 in every £3 that the Government spend now goes on social security, whereas, when Labour left office, it was £1 in every £4. Forget, above all, the imperative to reform."
We needed to change the social security system. Since 1948, it had "just grow'd", like Topsy. Bits had been bolted on to it in a haphazard way to meet new needs without any sense of trying to obtain a coherent pattern of provision for those in real need. The time had come to tackle that. I can take no credit for that. My predecessors and those of my right hon. Friend had the courage to face up to that in 1985 and 1986 and set the pattern that we shall now be able to implement.
I remember the vehemence with which Opposition Members criticised the sale of council houses. I remember


the way that they have adopted that, and now they do not want to go back to the old days. In a year or two, nobody will want to go back to the old system of social security.
It is worth reminding the House once more why we are implementing the reforms. We wanted to simplify a system that had become incomprehensible to claimants and difficult to administer. So far as possible, we wanted to get rid of the unemployment and poverty traps and to give people as much choice as possible.
Conservative Members did not make an issue of Mrs. Godden, but, as both the hon. Members for Livingston (Mr. Cook) and for Derby, South (Mrs. Beckett) have again raised the case, I thought that it might be worth going back to see what Mrs. Godden would have been entitled to when the Labour party was last in office. In 1979, Mrs. Godden would have been entitled to a mobility allowance of £10, attendance allowance of £14, a non-contributory invalidity pension of £16·80 and child benefit of £6·90. That comes to £47·70, which, uprated to current prices, gives a total of £96·50. Today she is entitled to £117·30.
I want to address the serious point about housing benefit put to me by some of my hon. Friends and by one or two Opposition Members. Of course, it is easy to select the capital cut-off of £6,000 and to say that, in some ways, it undermines the reform of housing benefit, but is should be worth the House's while to remember the benefits that will flow from the reform of that provision. In future, people in and out of work will be treated the same. There will be 100 per cent. support for rents and 80 per cent. support for rates for the most needy. We are now spending almost £5 billion on housing benefit. That is more money in real terms than the Labour party was spending when it left office.
However, I recognise my hon. Friend's concern when they talk about the £6,000 limit, and I ask them to address two issues. One of the benefits that has flowed from the reform of social security has been the alignment of the capital cut-off for all three income-related benefits. As my right hon. Friend the Secretary of State said, housing benefit is only one way of providing for the needs of poorer people. Income support provides another form of help for those people. I wonder whether my hon. Friends who urge a £6,000 capital cut-off for housing benefit would want to see all the income-related benefits extended in the same way.

Mr. Campbell-Savours: They want £10,000.

Mr. Scott: They want to raise it from £6,000 to £10,000.
Of course I recognise that a line, wherever it is drawn, will be open to criticism, but it is not right in principle that people who may be on broadly the same income as those on housing benefit should be subsidising those who are entitled to that benefit. I do not believe that it is proper targeting of any benefit when it goes to one household in three. Although I have listened carefully to my hon. Friend's arguments, I believe that, when we seek to target benefits as accurately as possible, it would be wrong to consider the capital limit at the moment.

Ms. Ruddock: Will the Minister give way?

Mr. Scott: No, I shall not give way.
I wish to deal with the serious point raised by the hon. Member for Birkenhead about the level of benefits. He accused the Government not just of an uncaring but of an

unchristian attitude towards the poorest in our society. I do not believe that the hon. Gentleman can sustain that argument.

Mr. Frank Field: rose—

Mr. Scott: The benefits that we are now administering are greater in real terms than they were in 1979. We have put substantial extra resources into those benefits, as the hon. Gentleman knows, so I do not know how he can complain that we have reduced them.

Ms. Ruddock: We do not have estimates in the London borough of Lewisham, but we now have assessments. There are 3,842 losers, compared with 2,758 gainers. Those people are losing sums of up to £25 a week. On the Government's assessment, they were poor people who were in need before the changes. They are now in even greater need.

Mr. Scott: I dare say that the hon. Lady is quoting from the local press. I am sorry that I gave way to her because I was trying to deal more broadly with the impact of the reforms. The Government's record in putting extra money in real terms into social security in excess of that paid out by the Labour Government acquits us of any accusations levelled by the hon. Member for Birkenhead or the hon. Member for Livingston of our being mean or not providing help for the poorest in our society. I am not ashamed to state that we want to target the help that is available on those who need it most.
Of course I recognise some of the apprehensions and concerns that have been addressed especially by some of my hon. Friends and by some Opposition Members. I have already given a clear undertaking that we will monitor carefully the impact of the reforms.

Mr. Nicholas Winterton: Will my hon. Friend give way?

Mr. Scott: This year we will be spending £48 billion on social security. By 1990 we are budgeting to spend £53 billion. We could not have done that unless we were running a successful and prosperous economy. I do not believe that there is any chance that if Labour Members were in charge of the economic affairs of this country they could conceivably afford the pattern of social security that we are affording at the moment. I ask the House to support the Government in the Lobby.

Question put, That this House do now adjourn :—

The House divided: Ayes 215, Noes 311.

Division No. 254]
[7.00 pm


AYES


Abbott, Ms Diane
Blair, Tony


Adams, Allen (Paisley N)
Boateng, Paul


Allen, Graham
Boos, Roland


Archer, Rt Hon Peter
Bradley, Keith


Ashdown, Paddy
Bray, Dr Jeremy


Ashley, Rt Hon Jack
Brown, Gordon (D'mline E)


Ashton, Joe
Brown, Nicholas (Newcastle E)


Banks, Tony (Newham NW)
Bruce, Malcolm (Gordon)


Barnes, Harry (Derbyshire NE)
Buchan, Norman


Barnes, Mrs Rosie (Greenwich)
Buckley, George J.


Beckett, Margaret
Caborn, Richard


Beggs, Roy
Callaghan, Jim


Beith, A. J.
Campbell, Menzies (Fife NE)


Bell, Stuart
Campbell, Ron (Blyth Valley)


Benn, Rt Hon Tony
Campbell-Savours, D. N.


Bennett, A. F. (D'nt'n &amp; R'dish)
Canavan, Dennis


Bermingham, Gerald
Carlile, Alex (Mont'g)


Bidwell, Sydney
Cartwright, John






Clark, Dr David (S Shields)
Livsey, Richard


Clarke, Tom (Monklands W)
Lloyd, Tony (Stretford)


Clay, Bob
Lofthouse, Geoffrey


Clelland, David
Loyden, Eddie


Clwyd, Mrs Ann
McAllion, John


Cohen, Harry
McAvoy, Thomas


Cook, Robin (Livingston)
McCartney, Ian


Corbyn, Jeremy
Macdonald, Calum A.


Cousins, Jim
McFall, John


Cox, Tom
McKay, Allen (Barnsley West)


Crowther, Stan
McKelvey, William


Cummings, John
McLeish, Henry


Cunliffe, Lawrence
Maclennan, Robert


Cunningham, Dr John
McTaggart, Bob


Dalyell, Tam
McWilliam, John


Darling, Alistair
Madden, Max


Davies, Rt Hon Denzil (Llanelli)
Mahon, Mrs Alice


Davies, Ron (Caerphilly)
Marek, Dr John


Dewar, Donald
Marshall, David (Shettleston)


Dixon, Don
Marshall, Jim (Leicester S)


Dobson, Frank
Martin, Michael J. (Springburn)


Doran, Frank
Martlew, Eric


Douglas, Dick
Maxton, John


Duffy, A. E. P.
Meacher, Michael


Dunnachie, Jimmy
Michael, Alun


Dunwoody, Hon Mrs Gwyneth
Michie, Bill (Sheffield Heeley)


Eadie, Alexander
Michie, Mrs Ray (Arg'l &amp; Bute)


Ewing, Mrs Margaret (Moray)
Milian, Rt Hon Bruce


Fatchett, Derek
Mitchell, Austin (G't Grimsby)


Fearn, Ronald
Molyneaux, Rt Hon James


Field, Frank (Birkenhead)
Moonie, Dr Lewis


Fields, Terry (L'pool B G'n)
Morgan, Rhodri


Flynn, Paul
Morley, Elliott


Foot, Rt Hon Michael
Morris, Rt Hon A. (W'shawe)


Forsythe, Clifford (Antrim S)
Morris, Rt Hon J. (Aberavon)


Foster, Derek
Mowlam, Marjorie


Galbraith, Sam
Mullin, Chris


Galloway, George
Murphy, Paul


Garrett, John (Norwich South)
Oakes, Rt Hon Gordon


George, Bruce
O'Brien, William


Gilbert, Rt Hon Dr John
O'Neill, Martin


Godman, Dr Norman A.
Orme, Rt Hon Stanley


Golding, Mrs Llin
Owen, Rt Hon Dr David


Gould, Bryan
Parry, Robert


Graham, Thomas
Patchett, Terry


Grant, Bernie (Tottenham)
Pendry, Tom


Griffiths, Nigel (Edinburgh S)
Pike, Peter L.


Griffiths, Win (Bridgend)
Powell, Ray (Ogmore)


Grocott, Bruce
Prescott, John


Hardy, Peter
Quin, Ms Joyce


Harman, Ms Harriet
Radice, Giles


Hattersley, Rt Hon Roy
Randall, Stuart


Heffer, Eric S.
Redmond, Martin


Henderson, Doug
Rees, Rt Hon Merlyn


Hinchliffe, David
Reid, Dr John


Hogg, N. (C'nauld &amp; Kilsyth)
Richardson, Jo


Home Robertson, John
Roberts, Allan (Bootle)


Hood, Jimmy
Robertson, George


Howarth, George (Knowsley N)
Robinson, Geoffrey


Howells, Geraint
Rogers, Allan


Hoyle, Doug
Rooker, Jeff


Hughes, John (Coventry NE)
Ross, Ernie (Dundee W)


Hughes, Robert (Aberdeen N)
Ross, William (Londonderry E)


Hughes, Simon (Southwark)
Rowlands, Ted


Illsley, Eric
Ruddock, Joan


Janner, Greville
Salmond, Alex


Johnston, Sir Russell
Sedgemore, Brian


Jones, Barry (Alyn &amp; Deeside)
Sheerman, Barry


Jones, leuan (Ynys Môn)
Sheldon, Rt Hon Robert


Jones, Martyn (Clwyd S W)
Shore, Rt Hon Peter


Kaufman, Rt Hon Gerald
Short, Clare


Kilfedder, James
Skinner, Dennis


Kinnock, Rt Hon Neil
Smith, C. (Isl'ton &amp; F'bury)


Kirkwood, Archy
Smith, Rt Hon J. (Monk'ds E)


Lambie, David
Snape, Peter


Lamond, James
Soley, Clive


Leadbitter, Ted
Spearing, Nigel


Leighton, Ron
Steel, Rt Hon David


Lewis, Terry
Stott, Roger


Litherland, Robert
Strang, Gavin





Straw, Jack
Welsh, Michael (Doncaster N)


Taylor, Mrs Ann (Dewsbury)
Williams, Rt Hon Alan


Taylor, Matthew (Truro)
Williams, Alan W. (Carm'then)


Turner, Dennis
Wilson, Brian


Vaz, Keith
Winnick, David


Walker, A. Cecil (Belfast N)
Worthington, Tony


Wall, Pat
Young, David (Bolton SE)


Wallace, James



Walley, Joan
Tellers for the Ayes:


Wardell, Gareth (Gower)
Mr. Frank Haynes and


Wareing, Robert N.
Mr. Ken Eastham.


Welsh, Andrew (Angus E)





NOES


Adley, Robert
Coombs, Simon (Swindon)


Aitken, Jonathan
Cope, John


Alexander, Richard
Cormack, Patrick


Alison, Rt Hon Michael
Couchman, James


Allason, Rupert
Cran, James


Amery, Rt Hon Julian
Currie, Mrs Edwina


Amess, David
Curry, David


Amos, Alan
Davies, Q. (Stamf'd &amp; Spald'g)


Arbuthnot, James
Davis, David (Boothferry)


Arnold, Jacques (Gravesham)
Day, Stephen


Arnold, Tom (Hazel Grove)
Devlin, Tim


Ashby, David
Dickens, Geoffrey


Aspinwall, Jack
Dorrell, Stephen


Atkinson, David
Douglas-Hamilton, Lord James


Baker, Rt Hon K. (Mole Valley)
Dover, Den


Baker, Nicholas (Dorset N)
Dunn, Bob


Baldry, Tony
Durant, Tony


Banks, Robert (Harrogate)
Eggar, Tim


Batiste, Spencer
Emery, Sir Peter


Bellingham, Henry
Evans, David (Welwyn Hatf'd)


Bendall, Vivian
Fallon, Michael


Bennett, Nicholas (Pembroke)
Farr, Sir John


Benyon, W.
Favell, Tony


Bevan, David Gilroy
Field, Barry (Isle of Wight)


Biggs-Davison, Sir John
Fookes, Miss Janet


Blackburn, Dr John G.
Forman, Nigel


Blaker, Rt Hon Sir Peter
Forsyth, Michael (Stirling)


Body, Sir Richard
Forth, Eric


Bonsor, Sir Nicholas
Fowler, Rt Hon Norman


Boswell, Tim
Fox, Sir Marcus


Bottomley, Peter
Franks, Cecil


Bowden, Gerald (Dulwich)
Freeman, Roger


Bowis, John
Fry, Peter


Boyson, Rt Hon Dr Sir Rhodes
Gale, Roger


Braine, Rt Hon Sir Bernard
Gill, Christopher


Brandon-Bravo, Martin
Glyn, Dr Alan


Brazier, Julian
Goodhart, Sir Philip


Bright, Graham
Goodlad, Alastair


Brittan, Rt Hon Leon
Goodson-Wickes, Dr Charles


Brooke, Rt Hon Peter
Gorman, Mrs Teresa


Brown, Michael (Brigg &amp; Cl't's)
Gorst, John


Bruce, Ian (Dorset South)
Gow, Ian


Buchanan-Smith, Rt Hon Alick
Gower, Sir Raymond


Buck, Sir Antony
Grant, Sir Anthony (CambsSW)


Budgen, Nicholas
Greenway, Harry (Ealing N)


Burns, Simon
Greenway, John (Ryedale)


Burt, Alistair
Gregory, Conal


Butcher, John
Griffiths, Sir Eldon (Bury St E')


Butler, Chris
Griffiths, Peter (Portsmouth N)


Butterfill, John
Grist, Ian


Carlisle, John, (Luton N)
Ground, Patrick


Carlisle, Kenneth (Lincoln)
Grylls, Michael


Carrington, Matthew
Gummer, Rt Hon John Selwyn


Carttiss, Michael
Hamilton, Hon Archie (Epsom)


Cash, William
Hampson, Dr Keith


Chalker, Rt Hon Mrs Lynda
Hanley, Jeremy


Channon, Rt Hon Paul
Hannam, John


Chapman, Sydney
Hargreaves, A. (B'ham H'll Gr')


Chope, Christopher
Hargreaves, Ken (Hyndburn)


Churchill, Mr
Harris, David


Clark, Dr Michael (Rochford)
Haselhurst, Alan


Clark, Sir W. (Croydon S)
Hawkins, Christopher


Clarke, Rt Hon K. (Rushcliffe)
Hayes, Jerry


Colvin, Michael
Hayward, Robert


Conway, Derek
Heathcoat-Amory, David


Coombs, Anthony (Wyre F'rest)
Heddle, John






Heseltine, Rt Hon Michael
Madel, David


Hicks, Mrs Maureen (Wolv' NE)
Major, Rt Hon John


Higgins, Rt Hon Terence L.
Malins, Humfrey


Hind, Kenneth
Mans, Keith


Hogg, Hon Douglas (Gr'th'm)
Maples, John


Holt, Richard
Marlow, Tony


Hordern, Sir Peter
Martin, David (Portsmouth S)


Howard, Michael
Mates, Michael


Howarth, Alan (Strat'd-on-A)
Maude, Hon Francis


Howarth, G. (Cannock &amp; B'wd)
Mawhinney, Dr Brian


Howe, Rt Hon Sir Geoffrey
Maxwell-Hyslop, Robin


Howell, Ralph (North Norfolk)
Mayhew, Rt Hon Sir Patrick


Hughes, Robert G. (Harrow W)
Mellor, David


Hunt, David (Wirral W)
Miller, Hal


Hunt, John (Ravensbourne)
Mills, Iain


Hurd, Rt Hon Douglas
Mitchell, Andrew (Gedling)


Irvine, Michael
Mitchell, David (Hants NW)


Irving, Charles
Moate, Roger


Jack, Michael
Monro, Sir Hector


Jackson, Robert
Moore, Rt Hon John


Janman, Tim
Morris, M (N'hampton S)


Jessel, Toby
Moss, Malcolm


Johnson Smith, Sir Geoffrey
Neale, Gerrard


Jones, Gwilym (Cardiff N)
Nelson, Anthony


Jones, Robert B (Herts W)
Neubert, Michael


Jopling, Rt Hon Michael
Newton, Rt Hon Tony


Kellett-Bowman, Dame Elaine
Nicholls, Patrick


Key, Robert
Nicholson, David (Taunton)


King, Roger (B'ham N'thfield)
Nicholson, Emma (Devon West)


King, Rt Hon Tom (Bridgwater)
Onslow, Rt Hon Cranley


Kirkhope, Timothy
Oppenheim, Phillip


Knapman, Roger
Page, Richard


Knight, Greg (Derby North)
Paice, James


Knowles, Michael
Parkinson, Rt Hon Cecil


Knox, David
Patnick, Irvine


Lamont, Rt Hon Norman
Patten, Chris (Bath)


Lang, Ian
Patten, John (Oxford W)


Latham, Michael
Pattie, Rt Hon Sir Geoffrey


Lawrence, Ivan
Pawsey, James


Lennox-Boyd, Hon Mark
Peacock, Mrs Elizabeth


Lightbown, David
Porter, Barry (Wirral S)


Lilley, Peter
Porter, David (Waveney)


Lloyd, Sir Ian (Havant)
Portillo, Michael


Lloyd, Peter (Fareham)
Powell, William (Corby)


Lord, Michael
Price, Sir David


Luce, Rt Hon Richard
Raffan, Keith


Lyell, Sir Nicholas
Rathbone, Tim


Macfarlane, Sir Neil
Redwood, John


MacGregor, Rt Hon John
Rhodes James, Robert


MacKay, Andrew (E Berkshire)
Riddick, Graham


Maclean, David
Ridley, Rt Hon Nicholas


McLoughlin, Patrick
Rifkind, Rt Hon Malcolm


McNair-Wilson, M. (Newbury)
Roberts, Wyn (Conwy)


McNair-Wilson, P. (New Forest)
Roe, Mrs Marion





Rossi, Sir Hugh
Thatcher, Rt Hon Margaret


Rost, Peter
Thompson, D. (Calder Valley)


Rowe, Andrew
Thompson, Patrick (Norwich N)


Ryder, Richard
Thurnham, Peter


Sackville, Hon Tom
Townsend, Cyril D. (B'heath)


Sainsbury, Hon Tim
Tracey, Richard


Sayeed, Jonathan
Tredinnick, David


Scott, Nicholas
Trippier, David


Shaw, David (Dover)
Trotter, Neville


Shaw, Sir Giles (Pudsey)
Twinn, Dr Ian


Shaw, Sir Michael (Scarb')
Vaughan, Sir Gerard


Shephard, Mrs G. (Norfolk SW)
Waddington, Rt Hon David


Shepherd, Richard (Aldridge)
Wakeham, Rt Hon John


Sims, Roger
Waldegrave, Hon William


Skeet, Sir Trevor
Walden, George


Smith, Sir Dudley (Warwick)
Walker, Bill (T'side North)


Smith, Tim (Beaconsfield)
Waller, Gary


Soames, Hon Nicholas
Walters, Dennis


Speller, Tony
Ward, John


Spicer, Sir Jim (Dorset W)
Wardle, Charles (Bexhill)


Spicer, Michael (S Worcs)
Warren, Kenneth


Squire, Robin
Wells, Bowen


Stanbrook, Ivor
Wheeler, John


Stanley, Rt Hon John
Whitney, Ray


Steen, Anthony
Widdecombe, Ann


Stern, Michael
Wiggin, Jerry


Stevens, Lewis
Wilshire, David


Stewart, Allan (Eastwood)
Winterton, Mrs Ann


Stewart, Ian (Hertfordshire N)
Wolfson, Mark


Stokes, John
Wood, Timothy


Sumberg, David
Yeo, Tim


Summerson, Hugo
Young, Sir George (Acton)


Tapsell, Sir Peter
Younger, Rt Hon George


Taylor, Ian (Esher)



Taylor, John M (Solihull)
Tellers for the Noes:


Taylor, Teddy (S'end E)
Mr. Robert Boscawen and


Tebbit, Rt Hon Norman
Mr. Tristan Garel-Jones.


Temple-Morris, Peter

Question accordingly negatived.

HEALTHJ AND MEDICINES BILL [Money] (No. 2)

Queen's Recommendation having been signified—

Resolved,

That, for the purposed of any Act resulting from the Health and Medicines Bill, it is expedient to authorise the issue out of the Consolidated Fund and repayment with interest into the consolidated Fund of any sum required for fulfilling any guarantee of the redemption or repayment of anhy stock issued or temporary loan raised by the successor company (within the meaning of any such Act) or of the payment of interest on any such stock or loan.—[Mr. Alan Howarth.]

Health and Medicines Bill

As amended (in the Standing Committee), considered.

ew Clause 12

TREASURY GUARANTEES

`(1) At any time when the successor company is wholly owned by the Crown the Treasury may guarantee, in such manner and on such conditions as they think fit, the redemption or repayment of any stock issued or temporary loan raised by the successor company and the payment of interest on any such stock or loan.

(2) Immediately after any guarantee is give under this section the Treasury shall lay a statement of the guarantee before each House of Parliament, and where any sum is issued for fulfilling such a guarantee or a guarantee such as is mentioned in subsection (6) below the Treasury shall, as soon as possible after the end of each financial year, beginning with that in which the sum is issued and ending with that in which all liability in respect of the principal of the sum and in respect of interest thereon is finally discharged, lay before each House of Parliament a statement relating to that sum.

(3) Any sums required by the Treasury for fulfilling any guarantee given or treated as given under this section shall be charged on and issued out of the Consolidated Fund.

(4) If any sums are issued in fulfilment of any guarantee give or treated as given under this section, the successor company shall make to the Treasury, at such times and in such manner as the Treasury may from time to time direct, payments of such amounts as the Treasury may direct in or towards repayment of the sums so issued and payments of interest on what is outstanding for the time being in respect of sums so issued, at such rates as the Treasury may direct.

(5) Any sums received by the Treasury under this section shall be paid into the Consolidated Fund.

(6) Any guarantee given by the Treasury under section 7 of the National Health Service Act 1966 with respect to a liability of the Corporation which becomes a liability of the successor company by virtue of section 1 above shall be treated as if it were a guarantee given under this section.

(7) Any guarantee given or treated as given under this section shall be extinguished when the successor company ceases to be wholly owned by the Crown.

(8) The successor company shall be regarded for the purposes of this Act as wholly owned by the Crown at any time when each of the issued shares in the company and the whole of any stock issued by it is held by, or by a nominee of, the Secretary of State.'.—[Mrs. Currie.]

Brought up, and read the First time.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie): I beg to move, That the clause be read a Second time.

Mr. Speaker: With this it will be convenient to take the following:
Government new clause 13—Statutory accounts of the successor company.
Government new clause 14—Corporation Tax.
Governments amendments Nos. 20 to 22 and 24 to 27.
Amendment No. 41, in clause 3, page 2, line 27, leave out 'section' and insert 'sections'.
Government amendment No. 28.
Amendment No. 44, in page 2, line 45, at end insert—
'2B. The Corporation shall have the duty to furnish the Secretary of State with an Annual Report on the performance of its functions, and the Secretary of State shall have the duty to publish the report and to lay copies of the report before both Houses of Parliament.'.
Amendment No. 43, in page 2, line 45, at end insert—
`2C. The Corporation shall have the duty to satisfy itself, after consulting such bodies as appears to it to represent the interests of the public within the National Health Service, that the loans made pursuant to subsections 2A (c) and 2A (d) are

available without discrimination in all areas of the country and to all medical practitioners in contract with a Family Practitioner Committee'.
Government amendment No. 29.

Mrs. Currie: On a point of order, Mr. Speaker. Government amendments Nos. 16, 17, and 18, which are further down the batting order, concern a definition of "private patient" and certain aspects of rights of admission to hospital. I undertook in Committee to come back on Report with a Government amendment which met the aims of Opposition amendment No. 117, which was debated in Committee. I am now advised that the amendments that we put down do not achieve what amendment No. 117 sought to achieve, nor do they meet our aims.
With the leave of the House, therefore, I shall not move amendments Nos. 16, 17 and 18. I undertake, however, to put down amendments in another place which will achieve those aims and reflect the sentiments of our discussion in Committee. I apologise to the House for that.

Mr. Speaker: I am sure that the House will be indebted to the hon. Lady for what she has said.

Mrs. Currie: The principal effect of our clauses today is to enable the Government to reconstitute the General Practice Finance Corporation as a statutory company under the Companies Act 1985. Right hon. and hon. Members will know that private sector finance is now readily available for lending against all sorts of properties, including doctors' premises. Even with the existence of the GPFC, many doctors are turning to the private sector to meet their needs for financing practice accommodation.
With such funds readily available and rigorous competition among lenders, it makes sense to concentrate public resources on those things which only the public sector can do. We therefore intend that a major and reputable financial institution should be given the opportunity to acquire the GPFC and continue to administer it in the interests of doctors and patients and possibly other professionals, such as dentists.
As well as commanding the confidence of private sector investors, we wish to retain the interest and involvement of family doctors in the business. To this end, we are undertaking discussions with their representatives and with the corporation as to how best to achieve this.
We are also seeking powers to influence the content of the memorandum and articles of association so as to safeguard the main objectives of the present corporation through the successor body, and Government amendments Nos. 21 and 22 modify and clarify those powers.
In clause 3(3), as members of the Committee will know, we are increasing the corporation's borrowing powers to ensure that it remains actively in business pending the conclusion of the new arrangements that we propose.
The new clauses put down today are required to clarify the tax position, particularly during the transitional period between the old corporation and the successor company. Without new clause 14, there would be a substantial tax liability, which, of course, has never been our intention.
New clause 13 will avoid an unnecessary audit.
New clause 12 is needed to ensure Treasury powers to guarantee new borrowing—and existing borrowing—by the successor company as long as the body remains in public hands.
The Government amendments are also intended to render the changes consistent with other privatisations so that we can draw on successful experience in negotiations to come. It is on that basis that I move the new clause.

Ms. Harriet Harman: We are concerned that there has not been any consultation about the new clause which is now being brought in on Report. In particular, there has not been any consultation about the way in which the clause and the amendments would work with the General Practice Finance Corporation, from which I should have thought that the Government would want to seek advice in respect of such complicated and technical clauses.
The annual report of the GPFC has still not been published although it was submitted some time ago—[Interruption.] Perhaps the Minister is saying that it has been published. Indeed, we are glad of that at long last.
We are opposed to flogging off the GPFC. The new clause and the Government amendments do not alter the fundamental problem of clauses 1 to 3.
There is a need to improve primary care. Although GP services are a vital part of primary care, there are still some places where people have to travel too far to get to a GP's surgery. We need a strategic organisation that is publicly owned, such as the GPFC, to ensure that finance is available for setting up surgeries in areas where private capital might not otherwise be available to finance them.
We want the GPFC to be publicly owned, accountable and used as part of the Government's armoury to improve GPs' premises and to make them more accessible to disabled people. At present, many GPs' premises are not so accessible. We want the GPFC to invest public money in improving the services that are available at GPs' premises and to enable GPs to have new equipment, such as computers and new diagnostic equipment. That should be the role of a publicly owned and accountable body, which would be used by the Government strategically to improve primary care services.
In many cases, GPs' premises are currently not fit for the task that they are required to perform, let alone for the task that we should like to see them develop in the future, with increasing emphasis on the prevention of ill health and the promotion of good health.
The Government are planning to flog off the GPFC, with all its interests in GPs' premises, to the private sector. It could be bought up by a drug company or by an American commercial health care company. The Minister mentioned "reputable finance institutions", but there are no guarantees in either the clauses or the new clauses that there will be a reputable financial institution. We have no guarantee that financial interests in GPs' premises will not be bought up by drug companies or by American or other foreign-owned commercial health care companies. The Government are opting out of a strategic role in a vital part of our primary health care services.
The Government have not offered any criticism of the way in which the GPFC has worked in the past. There is only one justification for abolishing it. The Minister talked about reducing public spending. The GPFC does not involve public spending. It breaks even or makes a profit. It does count against the public sector borrowing requirement, but only to the tune of one thousandth of 1 per cent.
Therefore, we are against the new clause that would abolish the General Practice Finance Corporation. We are

concerned that the Government have tabled the new clauses without any consultation. The new clauses do not deal with the main problems of clauses 1 to 3. Therefore, we cannot support them.

Mrs. Currie: On the point about consultation, I am sure that if the hon. Member for Peckham (Ms. Harman) were to read the amendments which, as she rightly says, are quite technical, she would realise that some have been drawn up directly in response to comments made in Committee by herself and her hon. Friends. We are concerned to ensure that the Treasury guarantee should continue during the period of transition. That was one point that was raised. I am sure that if we consulted almost everybody about whether there should be a new tax liability, which we had not realised might exist, their response would be that we should go ahead in bringing forward the amendments, which we have done.
I am sorry that the hon. Lady has not seen the GPFC annual report. It was published on 29 March 1988, which is now more than a fortnight ago. I shall ensure that a spare copy is at the back of the Chair for her so that she can read it in her own good time. It is really quite interesting. Much of what the hon. Lady has said—[Interruption.] There is a copy in the Library.
The hon. Lady will know from the long discussions that we had in Committee that we agree about the conditions of some GPs' premises. Indeed, we are trying to extend the provisions to dentists' premises, as there is room for improvement. We share her concern about premises not being accessible to disabled people. We also share her concern that some GPs do not always help equip their premises as they should.
In the remarks that she has just made, and possibly in Committee, the hon. Lady has shown a degree of confusion in her mind between the role of the GPFC and that of family practitioner committees. It is the job of the family practitioner committee to do all of the things that she has said. It has the powers to do so and we expect it to use those powers. Indeed, it could go so far as to withhold payments for rent and rates from premises that are not suitable. The GPFC does not have the role that the hon. Lady has identified. I think that she wanted a strategic planning organisation, that is the family practitioner committee.
The new clause satisfied some of the points that were made to us in Committee. Therefore, we are endeavouring to ensure that the handover to the private sector is as smooth as possible.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New Clause 13

STATUTORY ACCOUNTS OF THE SUCCESSOR COMPANY

'(1) For the purposes of any statutory accounts of the successor company—

(a) the vesting effected by virtue of section 1 above?—

(i) shall be taken to have been a vesting of all the property, rights and liabilities (other than any excepted property, rights and liabilities) to which the Corporation was entitled or subject immediately before the end of the last complete financial year ending before the vesting effected by virtue of section 1 above; and
(ii) shall be taken to have been effected immediately after the end of that year; and



(b) the value of any asset and the amount of any liability of the Corporation taken to have been vested in the successor company by virtue of paragraph (a) above shall be taken to be the value or (as the case may be) the amount assigned to that asset or liability for the purposes of the corresponding statement of accounts prepared by the Corporation in respect of that year in pursuance of section 8 of the National Health Service Act 1966.

(2) For the purposes of any statutory accounts of the successor company the amount to be included in respect of any item shall be determined as if anything done by the Corporation (whether by way of acquiring, revaluing or disposing of any asset or incurring, revaluing or discharging any liability, or by carrying any amount to any provision or reserve, or otherwise) had been done by the successor company.

Accordingly (but without prejudice to the generality of the preceding provision) the amount to be included from time to time in any reserves of the successor company as representing its accumulated realised profits shall be determined as if any profits realised and retained by the corporation had been realised and retained by the successor company.

(3) References in this section to the statutory accounts of the successor company are references to any accounts prepared by the successor company for the purposes of any provision of the Companies Act 1985; and in this section "complete financial year" means a financial year ending with 31st March.'.—[Mrs. Currie.]

Brought up, read the First and Second time, and added to the Bill.

New Clause 14

CORPORATION TAX

'(1) Subject to subsection (2) below, if on the day specified under section 1(1) above the successor company is a company limited by shares which is wholly owned by the Crown, it shall be treated for all purposes of corporation tax as if it were the same person as the Corporation.

(2) The successor company shall not by virtue of subsection (1) above be regarded as a body falling within section 272(5) of the Income and Corporation Taxes Act 1970 (bodies established for carrying on industries or undertakings under national ownership or control).'.—[Mrs. Currie.]

Brought up, read the First and Second time, and added to the Bill.

New Clause 15

SIGHT-TESTING

'The following section shall be inserted after section 20A of the Opticians Act 1958—

"Duties to be performed on sight-testing

20B.—(1) The Secretary of State may by regulations provide that, subject to any exceptions specified in the regulations, when a registered medical practitioner or registered ophthalmic optician tests the sight of another person, it shall be his duty—

(a) to perform such examinations of the eye for the purpose of detecting injury, disease or abnormality in the eye or elsewhere as the regulations may require, and
(b) immediately following the test to give the person whose sight he has tested a written statement?—

(i) that he has carried out the examination that the regulations require, and
(ii) that he is or (as the case may be) is not referring him to a registered medical practitioner.

(2) Except in circumstances specified in regulations under subsection (3)(b) of this section, it shall also be his duty to give the person whose sight he has tested, immediately following the test, either a signed, written prescription for an optical appliance or a signed, written statement that he does not need to wear or use an optical appliance.

(3) The Secretary of State may by regulations specifiy—

(a) particulars to be included in a prescription or

statement provided in fulfilment of the duty imposed by subsection (2) of this section; and
(b) circumstances in which that duty does not arise.

(4) A person shall not be required as a condition of having his sight tested—

(a) to undertake to purchase from a specified person any optical appliance the testing of his sight may show he requires to wear or use; or
(b) to pay a fee before the testing is carried out.

(5) A fee shall be payable in a case where a duty arises under this section only if that duty has been fulfilled.

(6) Any term of an agreement for a testing of sight which is inconsistent with this section shall be unenforceable, and any sum paid in respect of a fee otherwise than in pursuance of this section shall be recoverable.

(7) In this section "fee" means any payment in connection—

(a) with testing sight in accordance with regulations under this section;
(b) with fulfilling any duty imposed by this section; or
(c) with the supply of optical appliances.

(8) Any power to make regulations conferred by this section includes power to make different provision for different classes of case and shall be exercisable by statutory instrument, which shall be subject to annulment in pursuance of a resolution of either House of Parliament.

(9) In the application of this section to Northern Ireland—

(a) for any reference to the Secretary of State there shall be substituted a reference to the Department of Health and Social Services for Northern Ireland;
(b) in subsection (8) of this section, for the words from "statutory instrument" onwards, there shall be substituted the words "statutory rule, which shall be subject to negative resolution within the meaning of section 41(6) of the Interpretation Act (Northern Ireland) 1954".'.—[Mr. Newton.]

Brought up, and read the First time.

The Minister for Health (Mr. Tony Newton): I beg to move, That the clause be read a Second time.

Madam Deputy Speaker Miss Betty Boothroyd): With this it will be convenient to consider Government amendments Nos. 35 to 37.

Mr. Newton: New clause 15 replaces and, as we believe, improves upon, the existing clause 11. It is essentially a consumer protection provision, which commands support quite independently of the proposals in clause 10, which we shall come to at a later stage, concerning eligibility for NHS sight tests.
For the most part, the new clause repeats the requirement of the original clause—principally that, following any sight test, the practitioner must give the patient a written prescription or a written statement that there is no need for glasses; that it must not be a condition of carrying out the test that any spectacles required must be bought from any particular person; and that in any case where a fee is to be charged it must not be levied in advance of the test being performed and will not be enforceable if the duties laid on the practitioner have not been properly carried out.
There are two differences from the present clause 11. First, new clause 15 incorporates an additional requirement for the patient to be told in writing whether he is being referred to a doctor. The second difference, which is the reason we have a new. clause, rather than merely an amendment, is that we have decided that it is right to take the power, which curiously does not exist at present, to specify clearly in regulations what duties a practitioner must perform as part of a sight test.
As the House is aware, the sight test is generally understood and expected to include a test to establish


whether spectacles are required, and an eye examination in which signs of injury, disease or abnormality can be detected, leading perhaps to a need for onward referral. However, that does not rest on any specific statutory requirement. A current service committee case—concerning an NHS test, of course—has raised doubts about whether a practitioner is under any obligation to carry out an eye examination, as distinct from simply determining whether spectacles are needed. Therefore, subsection 1(a) is intended to provide the regulation-making powers to enable us to put the matter beyond doubt.
It is our intention that, under whatever arrangements people receive a sight test, there should be certainty about what they are getting and that it should include a proper eye examination. Of course we shall consult the professions when we come to draw up the relevant regulations. However, I can assure them that our general aim will not be to create so rigid a set of rules as to constrain the proper exercise of their professional judgment, but simply to maintain the existing arrangements, which have generally worked satisfactorily for patients and practitioners under the NHS.
I believe that the proposals to legislate in this way will be welcomed by the optical professions. They will put beyond doubt the requirements on them in relation to the sight test. Moreover, they will confirm the practitioners' primary care role in carrying out the eye examination on patients who present themselves and referring for further medical investigation or treatment cases where an abnormality is detected.
The associated Government amendments No. 35 to 37 do no more than eliminate the existing clause 11 to allow for the replacement and make a couple of consequential drafting changes.
I hope that on that basis the House will agree that the new clause is desirable and beneficial, and will agree to its incorporation into the Bill.

Ms. Harman: Perhaps I may mention at this stage that obviously we are not dealing here with the highly contentious abolition of the free sight test under the National Health Service, which we shall reach later.
The professional organisations have asked me to raise with the Minister some technical points. If he does not feel that they have been covered by what he has said, perhaps he will add something about them. The British Medical Association ophthalmic group committee thinks that the present arrangements are satisfactory because they require opticians to refer patients to their general practitioners if there are any signs of injury, disease or any other abnormality in the eye, or if a satisfactory standard of vision is not attained, even with corrective lenses. The committee says:
These regulations have been and remain adequate to protect the public. The wording of paragraph 20B(1)(a) may be contrary to its intent and undermine that protection.
There is also concern in the Association of Optometrists. Echoing the BMA view, it says:
there is a clear legal duty, which is not disputed by the Government, to refer any patient in whose eyes a practitioner sees signs of injury or disease. That duty is apparent as a consequence of Rules made by the General Optical Council under the provisions of the Opticians Act 1958.
We would, therefore, very much like to know why the Secretary of State feels it is necessary to have the provisions in (1)(b)(i) and (ii).
Perhaps the Minister could address himself in more detail to why he thinks that the current regulations do not satisfactorily protect the consumer so that there may be wider understanding about the matter.

Mr. Peter Griffiths: I wish to commend my right hon. Friend on the changes that he has proposed. It is important that the person who is carrying out the test shall be reminded not only of his obligation in conditions which may in future be much more competitive but that it is his job to test not just for glasses, but for the eye health of the patient.
Secondly, it is important that the patient should also be reminded that when he or she goes to have his or her eyes tested, the test is not merely to determine whether the person needs a pair of spectacles or stronger lenses but that, as a result of the test, the optician should give the patient a statement on any eye condition that is present. The patient must be aware of his or her rights.

Mr. Sam Galbraith: There is an interesting principle involved in what is inherent in subsection (1)(a), namely, beginning to define the necessary obligations and form of practice for a doctor or other professional. It is a principle which is becoming more and more dominant in specifying how a patient is examined and what is involved in an ophthalmological or ophthalmoscopic examination. That is a principle on which I have as yet undetermined views, unusually for me.
Subsection (3)(a) deals with the prescription. Subsection (3)(b) refers to the
circumstances in which that duty does not arise.
Can the Minister say in what circumstances he envisages that it would not arise that a patient who had had an eye examination, a sight test or whatever we wish to call it, would not necessarily be given a prescription?

Mr. Ronnie Fearn: I want to draw the Minister's attention to an issue which we shall not be able to debate today. When I saw the new clause, it seemed to be an improvement on the previous clause, but I thought that it might be improved further. One improvement would be to provide that a patient or, where appropriate, a parent or other representative understands the contents of the written statement, because some people might not understand what they were being offered.
Unfortunately, a gremlin appears to have attacked the administrative works and an amendment in these terms has been printed as though it applied to the original clause 11 and not to the new clause. This will be raised in another place but I trust that the Government will take note of the point.

Mr. Newton: I observe, in passing, the inaccuracy of the initial remarks of the hon. Member for Peckham (Ms. Harman) about the abolition of the free NHS sight test. Under any proposal that we have put forward there will continue to be a substantial number of free sight tests. Indeed, about one third of the population will continue to be entitled to free NHS sight tests under the proposals that the Government have put forward. That falls a long way short of abolition. I do not wish to make an issue of the point, but I did not think that the hon. Lady should be allowed to get away with slipping the reference in as an aside at the beginning of her remarks.
As to the points which were brought to the hon. Lady's attention by the BMA ophthalmic group committee and the Association of Optometrists, the point at issue is not


whether there is a duty to refer patients to their GP—the point on which her comments seemed to concentrate—but whether there is a duty to conduct an eye examination of the kind that might lead to referral to a GP.
I am more than prepared to consider any further representations that the hon. Lady or those bodies make if they have genuine concerns about the import of the proposals that we have brought forward. I can only repeat that the reason for the proposal, whatever views might be held about the nature of the existing law by those bodies, is that a service committee case concerning the carrying out of a sight test under the existing provisions has raised real doubts about whether there is a duty to carry out an eye examination. We do not want that doubt to continue. Therefore, we are seeking powers to eliminate the doubt by means of regulations.
I can only acknowledge and welcome what my hon. Friend the Member for Portsmouth, North (Mr. Griffiths) has said. Our purpose is to reinforce these important aspects of the sight test. Of course, the interests of the customer are at one with the interests of the practitioner and what the general body of practitioners will welcome.
I do not care to engage in the debate on grand principle offered to me by the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), not because I am fearful of principle or debates about principle. On the contrary, they are sometimes easier. However, this has been brought forward by the Government in the best possible pragmatic spirit to achieve what everybody agrees is desirable. It is on that pragmatic principle, if I may put it that way, that I stand.
The answer to the hon. Gentleman's point about the purpose of subsection (3)(b) is that a prescription as such is inappropriate when a patient is referred to a general practitioner or when a sight test is carried out not to establish a need for spectacles but, say, as part of a general health check to establish whether the person needs spectacles for occupational requirements, for example. The subsection is intended to cover a limited number of circumstances. At any rate, I can certainly assure the hon. Gentleman that there is no sinister intent.
The hon. Member for Southport (Mr. Fearn) raised some issues which, in studying some papers at an earlier stage today, or yesterday, I noted he had sought to raise in an amendment, seeking to establish that a practitioner should have a duty to make the meaning of a piece of paper clear to the person to whom he hands it. There is limited scope for misunderstanding a piece of paper that contains a prescription for spectacles, a statement that spectacles are not required, or a statement that somebody is or is not to be referred to a general practitioner.
I do not find it easy to understand how such a piece of paper can be misunderstood or how there can be some further need to impose on a practitioner a duty to explain such a piece of paper to the ordinary citizen. But if I can be persuaded that there is a genuine problem, of course I shall look at it. On the face of it, there can be few simpler pieces of paper that the citizen is likely to be handed, save only, of course, that he may not understand all the technicalities of a prescription and the way in which it is expressed.
I hope that I have dealt sufficiently with the points that have been raised and that the House will proceed to adopt the new clause.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New clause 1

CERVICAL CYTOLOGY SCREENING

'Each district health authority shall operate a comprehensive computerised call and recall system for cervical cytology screening of all women within the district over 20 years every three years.'.—[Ms. Harman.]

Brought up, and read the First time.

Ms. Harman: I beg to move, That the clause be read a Second time.
Every year, over 2,000 women in this country die of cervical cancer. At least half would be saved if we had a proper, comprehensive computerised call and recall system in operation. Women are still dying of cervical cancer, and, because of the Government's failure to act, they will continue to die. The reason is quite simple. Instead of asking themselves only how much money they can save, the Government ask themselves only how much money they can save. As long ago as 1981, the Government were told by their own expert committee for gynaecological cytology that they should take action. They were told that cervical cancer gives an early warning signal and that that signal can be detected by taking a smear, which is a completely painless procedure, and examining it in a laboratory. If a pre-cancerous cell is discovered, the condition can be treated.
There was nothing tendentious or controversial about the report. Indeed, it appeared at the end of many years of international debate and experience. Despite their rhetoric about preventing ill health, the Government have failed to act on the report's recommendations. The report proposed that each district health authority should set up a computerised scheme and invite women to have smear tests, and that the tests should be repeated at regular intervals. The report firmly stated that it was not good enough simply to urge women voluntarily to come forward for a test. That approach had been tried and had failed, and women were still dying of cervical cancer.
The Government did not act on that advice. It was not that they disagreed with the advice; they just did not follow it up. I am certain that they would never have even begun to act had they not been pushed month by month and year by year, and we still have not got there. What has been achieved stands not at all to the credit of the Government, but to the credit of those outside the Government who have relentlessly campaigned on the issue. I pay tribute to my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) who, as shadow Health Minister, led the campaign in Parliament.
If a woman asks me whether she should have a smear test or wait until she is called for a test by her local health authority, the best advice that I can give her is, "I do not think that you should wait to be called, because you might be not be called for a further five years and you could be dead before then." If the Minister is honest, she will admit that that is still the best advice. Indeed, I recently saw her on television urging women to put themselves forward for smear tests. Why does she still have to give that advice


seven years after she was told that the Government must set up a call and recall system on a district basis? Sadly, the answer is because the scheme is only just starting.
7.45 pm
After the Government's announcement last year that they intended to require district health authorities to set up a call and recall scheme, I became concerned that, for the sake of political advantage, the Minister might announce to the nation that the cervical cancer problem had been solved and that no one need worry about it any more.
To check whether the problem had been solved, staff in my office and I telephoned every district health authority which, according to the Government, was due to set up a computerised call and recall scheme between March 1987 and the end of March this year. There were 83 of them. The survey was based on speaking to each district health authority about what was happening in its area. The survey showed that by the end of 1993, 36 per cent. of the districts will not have called all women between the ages of 20 and 65 years for their first smear test. That means that, 12 years after the Government's expert committee's report was published, there will still be women who have never had or even been called for a smear test.
The very least that the Government can do is to accept the new clause and agree that, up to and possibly beyond 1993, their failure to act will result in the unnecessary death of women from cervical cancer. The Government's failure to act is directly attributable to their obsessional opposition to public spending and to the Health Service. There can be no other explanation for their failure to act on such clear medical advice.
In 1981, when the Government were told that there was conclusive evidence that cervical cancer could be detected and prevented, they should have jumped at the chance to save lives, but, perversely, they are the enemy of medical advance and the opponent of new life-saving treatment. They see them only as extra demands on the Health Service. As well as being morally bankrupt, that approach is a false economy. The British Society of Clinical Cytology estimates that it costs £30 million a year to nurse and treat the 2,000 women who die from cervical cancer, to say nothing of the financial support that is needed for the children whom they leave behind.
All is not well even where computerised call and recall systems are in operation. The Government have failed to ensure proper laboratory services to back up the schemes that are being set up. National Health Service laboratories are finding it hard to recruit staff because the pay does not compete with private sector pay. I shall refer to two districts, although the picture is the same throughout the country.
A report to the Oxfordshire health authority on laboratory work loads states:
During this financial year there were no suitable applicants for the ‖ vacant post. The inability to fill the vacancy is due to lack of applicants with suitable training. Trained people are rare on the job market and if they exist they find it difficult to move to Oxford because of house prices.
It goes on to state:
Two other vacancies have been filled by trained MLSOs who do not have cytology experience. These two people are being trained by experienced MLSOs hence cutting down on the productivity of the latter.
In the Bloomsbury district health authority last year, five out of 11 laboratory posts were vacant. It is worrying that the Government are so unconcerned that they do not

even know the full level of laboratory vacancies throughout the country. I hope that they will not once again leave it to us to do a survey of all laboratories to show the full national picture of vacancies. The Government must take action.
The problem is that the Government are trying to provide the service on the cheap, and laboratory staff are voting with their feet. This means that the more women are called for a smear, the longer they will have to wait for the results to be sent back to their doctors. In a parliamentary answer to me, the Government acknowledged that already 53 districts—more than one fifth of the country as a whole—are taking one month or longer to send the results of smear tests back to women's doctors.
This means that at least one fifth of the districts are already failing to achieve the targets set down in the Government's own guidelines for the turnround time on smear tests. I urge the Minister to find out how many vacant posts there are in the laboratories and to ensure that the pay is increased so that this responsible job becomes attractive and the Health Service can compete with the private sector.
Let me ask the Minister two specific questions relating to the inaccurate diagnosis as negative of smear tests at the women's hospital in Liverpool between 1983 and 1985. That occurred because of what was later officially described in a report as
a massive error of professional judgment".
First, will the Minister tell us whether compensation has been assessed and paid to those women who went on to develop invasive and untreatable cervical cancer as a result? Secondly, I should like the Government to report to us on the progress of the national quality control checks on smears—a procedure that was revised after the Liverpool episode.
Will the Minister require health authorities to recall women at three-year intervals? In the past, the Government have not been very good at taking expert medical advice, even when it has been unanimous. They have failed in that respect on this issue. Here is another opportunity for them to take the advice of medical experts. Medical opinion, including the opinion of the British Medical Association, is now unanimous that women must be tested every three years, and not just every five years. A report of the inter-collegiate working part on cervical cytology screening, conducted by the Royal College of Obstetricians and Gynaecologists, the Royal College of Pathologists, the Royal College of General Practitioners and the Faculty of Community Medicine backs up the argument that the interval between tests should be three years.
In Oxford it was assessed that to leave the test for five years would be
bad medicine, especially when disease prevention is a priority. It would result in twice the number of invasive cancers of the cervix in this District.
I should hate the Government to respond to the problems in the laboratories and the district health authorities by simply saying, "We will leave the interval at five years." The Government should take the issue seriously. They should make sure that they sort out the problems in the laboratories, and they should require district health authorities to screen women every three years.
The Government must also ensure that district health authorities, family practitioner committees and general practitioners have enough resources to run the schemes


successfully. We do not want to find that in two years' time district health authorities are having to make difficult decisions about whether to keep their cervical cancer screening programmes or to make cuts in some other life-saving services.
Will the Minister set up a national advertising programme to encourage women to go for tests, because we are concerned about the take-up rate? Even for the schemes that have been going for some time it is difficult to know what the take-up rate is because there have been problems with the computer software which the Government have not ironed out. There is not a great deal of hard evidence about the take-up rate, but we suspect that it is lower than it should be.
We know that the take-up rate for cervical cancer tests would be greatly improved by a television advertising campaign. A letter calling a woman for a smear test would have more effect if, before it dropped on her mat, she had seen advertisements on the television explaining the importance of responding to the call and going for a test. The Department of Trade and Industry has recently spent £5·6 million on its television advertising campaign on the so-called enterprise initiative. It seems to me that if the DTI can spend that sort of money on advertising a bogus initiative, it is well worth the Department of Health and Social Security spending money on an advertising campaign that would actually save women's lives.

Mrs. Gillian Shephard: I think that I am right in saying that all family practitioner committees had computers installed for call and recall as long ago as February and that all of them now have the complete age/sex registers on computer.
I have a particular interest in this matter because before entering this House I was chairman of a health authority which had its computerised call and recall system in place last June. It seems to me that the hon. Member for Peckham (Ms. Harman) has painted an unnecessarily gloomy picture. We are one of the few countries that now has a fully computerised and comprehensive call and recall system, and only an impractical person would imagine that such a system, which has involved many, many hours of personnel input, could possibly work instantly, correctly and perfectly—as we all hope it will—within a few short weeks.
I know from practical experience that in my own health authority it took some time for the gremlins described by the hon. Member for Peckham to be smoothed out of the computer. Earlier, my right hon. Friend the Minister for Health said that we were talking about pragmatism and principles. The principle has been recognised and is in place, but pragmatically we have to wait to be sure that it is working effectively everywhere.
Obviously, all hon. Members have every sympathy with the aim of the new clause in reducing screening time to three years. However, I know from practical experience that if we pile task upon task on GPs, family practitioner committees and health authorities, we severely risk losing the advantage that we have gained in having installed the system already. If we overload the system now, before the initial difficulties are smoothed out, we shall not be able to respond to the needs of women in this very important area of preventive health care.
I quite agree that one of our first aims must be to raise the consciousness of women about the importance of cervical cancer and I am sure that all of us, as Members of Parliament, are busy doing just that. However, I am not sure about the effectiveness of a television campaign. Most people are perfectly capable of responding to an invitation that falls on their doormat; I am sure that my constituents are. The important point is that the principle has been recognised and the machinery is in place. As I said before, we are one of the few countries that has recognised the importance of having such a system and is carrying out the work and I strongly urge that we should not overload the system so that we lose the advantage that the Government have put in place for all women.

Mrs. Llin Golding: It cannot be said too often that cervical cancer killed 2,000 women last year. This killer disease can and should be eradicated, but how many health authorities are experiencing the problems that we have in North Staffordshire?
On 21 January, I wrote to the Minister about a women who had had a smear done on 15 September last year but who had received the results on 6 January this year; she had waited 16 weeks. Unfortunately, that lady had an abnormality that required immediate treatment, but she had had to wait 16 weeks. On 10 February, I had a letter from the Minister saying that the waiting time in north Staffordshire was between 10 and 12 weeks. On 16 February, I had a letter from the community physician for north Staffordshire saying that the waiting time was eight weeks.
On 19 February, I had a letter from the district health authority chairman saying that the waiting time was now eight weeks in North Staffordshire. There had been problems with maternity leave and sickness but the tests were now being sent to other pathology laboratories and the waiting time was down to eight weeks. On 24 February, I had a letter from a lady who had had her test on 15 October and whose results were returned on 18 February. That was 18 weeks waiting time. She said that she had never felt so depressed about anything in her life, and that week after week she had worried herself silly.
On 8 March, the Minister replied to me and claimed in her letter that the waiting time was eight weeks in north Staffordshire. On 25 March, I received my smear test result, almost 11 weeks after I had had the test. Meanwhile, I have had a letter from the chairman of the family practitioner committee which said that the committee was considering abandoning all tests in north Staffordshire for four weeks because it could not cope.
For some time, north Staffordshire has had a call and recall system. Like the hon. Member for Norfolk, South-West (Mrs. Shephard) I served on a district health authority when this system was installed. It is a good system but what comfort is it to the women of north Staffordshire when the family practitioner committee says that it cannot use its expensive life-saving system because it cannot cope? What comfort has the Minister to offer the people of north Staffordshire?

8 pm

Mr. Peter Griffiths: I am sure that we have all listened with concern and perhaps shock to the speech of the hon. Member for Newcastle-under-Lyme (Mrs. Golding). I am sure that my hon. Friend the Minister will take note of what has been said. The House resolving to reduce the


period of recall under a computerised system would not alter by one jot the situation that the hon. Lady had described. The position would not be improved by the new clause.
We need a far more personal approach to testing and re-testing. I wished to intervene in the speech by the hon. Member for Peckham (Ms. Harman) to say that, no matter how efficient a computerised recall system may be, there will always be those who, because of moving from one place to another or because of living in houses in multi-occupation, do not receive the regular postcard recalls. It is important to seek to place the responsibility firmly on women to ensure that it is their task to seek the important advice that they can get from testing.

Mr. Galbraith: How can that be done?

Mr. Griffiths: I am about to make some suggestions about that, and I can do so without the hon. Gentleman's help.
No hon. Member has mentioned an approach to women who are at the receptive age young women at school or at college. That is the time at which young girls should have drawn to their attention the fact that these tests are not carried out just once or that at some time in the future they ought to seek them, but that it is a process in which they have a personal responsibility for their own health and well-being in the years to come. A campaign directed at sixth forms and colleges would be perhaps the most effective way of setting in train the responsible attitude that we wish to see.
Because of age and lifestyle, some women are acknowledged to be particularly at risk, and they should be reminded of their responsibility. If they move from one part of the country to another and then move on again, they should not wait for the system to catch up but should seek treatment. The weakness of the new clause is exemplified by the attitude of some Opposition Members who interrupted me when I suggested that we should ask women to help themselves. The idea that we can rely on a computerised system is quite wrong. The primary responsibility for health care rests with the individual, and we should start to inculcate that feeling in schools and colleges.

Ms. Ruddock: I support the new clause moved by my hon. Friend the Member for Peckham (Ms. Harman), with whom I share a local district health authority. I commend to the House the practice of that health authority, Lewisham and North Southwark. It takes the view that the greatest public interest and the specific health interest of women can be served only by having a call and recall system with a three-year interval for women between the ages of 20 and 65. That is the scheme that the authority has put in train. It is one of the health authority districts that was able to meet the Minister's deadline, and it sent out its first call list by 31 March. It was able to do that only because of the extreme dedication of the staff who are pioneering the scheme and who carried out all the work prior to the Government bringing in the legislation.
Having decided to carry out the scheme, the authority found, as all health authorities will find, that there are constraints on finance and personnel. Let us first examine the financial constraints. The simple smear test will not in itself save the lives of women. It must be backed by expert colposcopy if we are to take advantage of the best medical practice. In Lewisham and North Southwark, there was

until recently a five-month delay for colposcopy. I hope that Conservative Members will note that that means that women who are told that the smear is abnormal will wait in absolute terror until they are called for the vital further work that will confirm whether the abnormality is trivial or signals terminal illness.
The provision of colposcopy services has not been adequately dealt with to enable it to match the simple smear test and the call and recall provisions. For Lewisham and North Southwark district health authority to deal with that problem and to reduce the five-month delay to one month, which is its target, and to deal adequately with the only 40 per cent. response that it expects from the call-in system, it has had to find £27,000 in capital and an extra £13,000 in revenue.
The Government have not provided that money. It has had to be found by taking money from one part of the budget to fund another part. In order to fund the system, other parts of the Health Service in Lewisham and North Southwark have had to be cut. No woman and, I hope, no man who wants to see this life-saving system in operation wants to see it instituted at the expense of other parts of the much needed Health Service.
Will the Minister confirm that at the moment category one carcinoma in situ is not being subjected to colposcopy examination? I understand that that is the case in Lewisham and North Southwark, although the authority believes that the ideal and best clinical practice demands that such conditions are properly investigated. It would be extremely serious if the scheme for encouraging women to come forward for testing were to be inadequate so that pre-cancerous stages were not subjected to the best possible clinical investigation.
Finally, I turn to the question of technicians. As my hon. Friend the Member for Peckham said, there is a shortage of medical laboratory scientific officers. My district health authority is aware of this and is enthusiastic about recruiting trained people. The authority has told me that when it advertises it receives no applications from that category of health worker. It is partly to do with the fact that wages are so low but it is also because there are far too few people with adequate training. The health authority is in a position to offer skilled people to provide training. It would like to have training on a regional basis, but, of course, again there is no provision and there would be no funding unless it stole money from some other part of the budget.
I ask the Minister to tell us whether any advice is being given to general practitioners about spatulas. As has been said, there is far too high a rate of false negatives. We should like to know whether that could be improved, as some of the literature suggests, by encouraging GPs to cease using the Ayre spatula and to use the Aylesbury or some other spatula. Clearly it is in all our interests that, once women are in the computerised system, they should not be misled, especially when there are ways in which we could improve the accuracy of the diagnosis.

Dr. Lewis Moonie: I must apologise to hon. Members for coming to the debate late. I was chairing a Committee upstairs and I came as soon as I could. I am grateful for the opportunity to speak on this subject.
I am aghast that there can be any question of Government Members opposing the new clause. Screening for cervical cancer is the epitome of a preventive medical technique. In the whole sphere of cancers, it is the only


occasion on which we can find a pre-cancerous lesion and treat it successfully in every case. Therefore, it is mandatory for us to use the techniques that are available to maximise a woman's chance of benefiting from such a technique. I know of no medical opinion anywhere in the world that would recommend anything other than a three-yearly period for screening. If the Minister can offer any other informed evidence on the subject, I would be only too glad to receive it. The economic and medical case is unanswerable. It saves lives and, in the long run, it saves money because the treatment of women who develop cancer is an expensive business.
As I have said, it is a preventive medical technique and that means that we must encourage women, if possible, to take advantage of it. We can do that by three methods. The standard procedure in health education is to inform women, to increase their knowledge and hopefully to modify their attitudes. Through doing that we can hope to change their behaviour. It is always easy to inform people about a technique, but it is much more difficult to change their attitude and much more difficult still to change their behaviour.
We are talking about two groups of women. We are talking about a group who will benefit from screening of any sort; those who will respond to the request to come for screening. That group includes the majority of women about whom we are talking. Sadly, there is another group who do not respond to any form of call by letter for many reasons.
In my area in Fife, one of my former colleagues has conducted extensive research on the subject of women's attitudes to screening and the things that modify their take-up of it. For example, the availability of screening, when they can go, facilities for looking after children and whether they can attend when they are at work all play a key role. Perhaps most important is the issue whether they can have a woman doctor to carry out the technique. That is very important for many women, particularly older women.
Not only do we need an efficient system for those who will take advantage of it; we need to conduct research into modifying general behaviour. We must not rely on the individual's behaviour alone. Appeals to individual behaviour do not work and that is why I oppose them. I notice that the Minister agrees with that.
Even if every woman on the average GP list were to respond to the call—let us say there are 800, and that is an overestimate—screening every three years instead of every five would mean a difference of less than two cases per GP per week. That is taking no account of the fact that half of the women may be attending a community health clinic anyway. That is not an overwhelming burden of work for a GP, and it is wrong to suggest that it is. It is something with which they could easily cope. I commend the new clause to the House and I hope that it will be passed.

Mr. Galbraith: I want to respond to the comments by the hon. Member for Portsmouth, North (Mr. Griffiths). I do not disagree with him, but I want to develop what he said. He said that the way forward is for people to look after their health and that it is all about taking a cold shower in the morning, going for a run, and so on. Those

methods are favoured by the Minister. He said that each individual has responsibility for his or her health, and we accept that. However, on top of that is another important layer and that is what is involved in the new clause.
There should be a suitable call and recall system to ensure that as many women as possible have the test. That is what it is all about. We are not talking about removing responsibility. There will always be people who will accept responsibility for themselves, but, as I have said, there is another layer.
I want to re-emphasise what was said by my hon. Friend the Member for Kirkcaldy (Dr. Moonie). As he said, the systems involved in the technique are curative. Other systems of screening for cancer, such as chest X-rays, barium meals, and so on, can detect a cancer which may be excised, thereby preventing complications. However, that is less than curative. This type of screening detects a pre-cancerous condition, which, if dealt with, can be cured and cancer does not develop. That is the important difference and that is the importance of the new clause. That is why we are asking all hon. Members to support it.

Mrs. Rosie Barnes: I want to add my weight to the request for a proper review of laboratory technicians, their career structure and pay levels. It is a severe problem in my area and it may well be more responsible than any other single factor for the delays in women receiving a response to a test that they may have had some weeks or months previously.
I was approached recently by a dedicated laboratory technician who had been in her present location for many years. She said that on average once every two months she is offered a job in the private sector for about double her current salary. She is dedicated and is staying in the NHS but is seeing staff leave at a considerable rate. That problem needs to be resolved.
Advertising has already been mentioned tonight and a call has been made for an advertising campaign to be used to draw attention to the value of responding to the system. I find it intriguing that whenever a call is made for advertising in a matter such as this we hear streams of advice about how advertising is not really effective. I do not find that argument convincing. We all know that the private sector spends millions of pounds. It conducts research on its advertising and its effects and it does that because it works. It would work just as effectively in this area in encouraging women to come forward.
We all know that women who read the medical pages in newspapers, watch television programmes and perhaps listen to the valuable work that "Woman's Hour" on Radio 4 has been doing, are likely to be influenced and to come forward. However, there are women who watch television between 7 and 8 pm who are not listening to those programmes or reading the articles, but whose lives may be saved by triggering them into attending. I recommend that that be given serious consideration.

Mrs. Currie: This has been an interesting short debate, and I am particularly grateful for the comments made by my hon. Friends the Members for Portsmouth, North (Mr. Griffiths) and for Norfolk, South-West (Mrs. Shephard). We share the views expressed on both sides of the House about the possibility of saving lives by the mass screening of adult women for cervical cancer. Opposition Members know that I mean that.
The major killer of women before their time in this country is not cervical cancer but breast cancer. As hon. Members know, we are developing a full breast cancer screening programme throughout the country, and we shall be the first major country to have such a system. The next largest killer of women before their time is lung cancer. Indeed, in Scotland, it is the biggest killer. Hon. Members know my views about that subject, and I hope that they share them.
Cervical cancer is significant, because most deaths from it are unnecessary. In its treatable, pre-cancerous phase, which may last 10 years or more, it is symptomless, and the simple, cheap way to find it is the smear test, which has been available for nearly 25 years. If it is not detected in time it kills, and the number of deaths from it stand at 2,000 per year, although the figure has been dropping slowly over the past decade.
For many years, the number of cases of invasive cancer has been about 4,000 per year. If we had not reached those ladies in the way that we have, the death rate would have been much higher. However, our concern continues, because the majority of deaths are among older women who have never been screened and perhaps have not visited their doctor for many years. An opportunistic system, which is the system which has operated in other countries, simply will not do.
We agree with the hon. Member for Peckham (Ms Harman) that we need a systematic mass screening service for which all women receive invitations to attend. Our other major concern, which the hon. Lady did not mention, is that there is a new, more aggressive form of cancer appearing in small numbers among younger women. It is relatively rare and may be linked to a virus. Changes in behaviour may assist in preventing its further spread, and links with the increasing smoking behaviour of young women have been implied. That is why the practice that has been extant for more than 20 years of concentrating attention on older women is not enough. Of course large numbers of younger women are tested already—for example, when receiving contraceptive advice—but the bulk of the 4 million tests that are currently being carried out are on younger women.
I listened to the hon. Member for Peckham with great interest. I have read the articles that she has written. There was one in the Morning Star this week. For the past few weeks she has been saying that I am wrong in saying that the system is about to be up and running. When people say that I am wrong there are three possibilities: they are right—occasionally that happens—they are being mischievous or they are dim. The hon. Lady is not right, she does not look like the sort to cause trouble, so I am left with the third conclusion—[Interruption.] If the hon. Lady will listen, I shall explain why the thought keeps flicking into my head that perhaps she is being a bit dim about this matter.
For over 20 years, Governments have been trying to introduce a comprehensive screening system for precisely the reasons that the hon. Member for Peckham has given, which I endorse. The new clause asks us to introduce a new system, but that is unnecessary because we have already done so. In 1966, the Labour Government said that GPs should be responsible for screening, and they offered incentives for them to do so, and we have continued that system. However, that did not work because the take-up was poor.
In 1971, the Conservative Government tried to set up a national recall system based in Southport using manual records. Given the complexity of the task, we should not be too surprised that it did not succeed.
In 1981, the Government decided that the system would work better at local level. Many highly successful screening services were set up following the 1981 initiative, such as the one in Cambridge, and there are some excellent, long-established services in Scotland that have been well-researched and written up.
By 1985 it was apparent that having a variety of schemes—some manual, others using computers and some having different software—was fine in areas that were well organised and enthusiastic, but they left out large parts of the country, often parts where cervical cancer was a problem. In 1985, my right hon. and learned Friend who is now the Chancellor of the Duchy of Lancaster decided that we should move to a call and recall system, consistent throughout England, so that all women could have a chance of accepting an invitation to be screened.
The computer implementation programme was carried out between December 1985 and February 1988. Originally, it was scheduled to take a full three years. It has cost £10 million, involved installing computers at 65 different sites, providing more than 750 VDU terminals for the family practitioner committee staff, and converted over 33 million clerical records. It has been a massive exercise. The entire family practitioner system has been cornputerised, offering many exciting opportunities for prevention of disease in the future.
No one has said what I am about to say. We should all thank and congratulate everybody concerned in that major exercise. It has involved an enormous amount of work not,—just as the hon. Member for Lewisharn, Deptford (Ms. Ruddock) said, some years ago, but in recent weeks and months as well.

Mr. Frank Dobson: The Minister says that in 1985, with some burst of insight, the Government decided that schemes should be implemented. Will she say why, with computerised call and recall systems, national standards and national publicity having been recommended in every part of the country since 1981, the Government did not do a damn thing until 1985?

Mrs. Currie: The hon. Gentleman is fairly typical of Socialists in this country. He is interested only in what happened in the past. We are interested in what is happening now.
We have completed the computer implementation programme six weeks ahead of schedule. As a result, every English family practitioner committee has a computerised register, and all but nine of the 190 district health authorities have screening systems under way. The rest, which are mainly in one Thames region, will be no more than four weeks behind. We are the only country within the European Community with such a comprehensive programme, and this achievement puts us ahead of all the major nations.
France, Italy and even West Germany, which has a much higher spend on health than ourselves, have no nationwide service, and only 30 per cent. of at-risk women are screened in West Germany. Further, America, Spain and Holland do not have such a system. In the western world only Sweden, Finland and tiny Iceland have a


similar system. It is time that Opposition Members recognised that we have such a system. They should say, "Well done, and congratulations to all concerned."
It is worth pointing out that some of the areas that are not yet on target, but which will be on target within the next few weeks, have had a screening system for some time. Inevitably, implementation of the system is at different stages in different districts. Some areas have had the system for a long time, some are issuing prior notification lists to GPs, some are concentrating first on a particular age group or a particular number of GP practices and others are undertaking a gradual introduction to check the system, particularly where equipment is newly installed.
On publicity, we do not rule out a national campaign, but all the evidence shows that local efforts are much more effective. There is plenty of evidence, including a recent edition of the British Medical Journal, that a sympathetic and personal invitation from the GP produces the best response. We are even advised that the colour of the letter should be pink, as it produces a better response. There will be much local publicity. For example, the northern region is considering a publicity campaign to encourage women to respond to the programme. All 16 districts have been live from 1 April. Yorkshire region tells me that its system is up and running. The system is up and running in Trent region, and it became operative in Leicester on 31 March. Mersey region tells me that it held a press conference earlier this year when all five Cheshire districts started up, thus giving women an opportunity to respond.
It is clear that we should remind people, including GPs, that we are testing for microscopic changes that are rare. If someone is told that she has an abnormal smear, almost certainly it does not mean that she has cancer. It probably means that there was something wrong with the slide or that she has a mild infection. The microscopic changes that lead to cancer are still very rare; the vast majority of slides are clear. The best advice that the hon. Member for Newcastle-under-Lyme (Mrs. Golding) could give to her constituents is, "Do not worry," and that is entirely right.

Mr. Galbraith: Will the Minister give way?

Mrs. Currie: No, I do not have time.
European Cancer Week, which will run from the first week of May, will give wide publicity to a 10-point code against cancer. Two of them advise women to be screened for breast and cervical cancer. Therefore, in that particular week and in European Cancer Year—next year—we shall have the opportunity to raise the issue nationally.
Opposition Members raised the question of laboratory backlogs. Those are monitored every month and we chase the small number of district health authorities that have backlogs. The vast majority do not. In north Staffordshire, the average delay at 23 March was confirmed at eight weeks. Some slides from before Christmas have been held back because the health authority wanted to distribute batches of slides to other laboratories, but they will all be dealt with in the usual way. The hon. Member for Peckham should remember what I said earlier. The median times between the time when the very first pre-cancer stages are detectable and the point at which cancer becomes inoperable is 12 years. On that basis, I am sure that the hon. Lady's constituents are being well looked after.
8.30 pm
As for staff shortages in laboratories, the number of screening staff has increased by nearly 12 per cent. between 1985 and 1986—the last year for which I have details. It is worth reflecting on the fact that the total whole-time equivalent of screening staff in England was 778 at 31 December 1987, and during that year the total number of smears taken was 37 million. The Royal College of Pathologists and the British Society of Clinical Cytology recommend that a screener should deal with 7,000 smears a year. I invite Opposition Members to do their sums. Nationally there are sufficient staff. Occasionally there are local problems and, when there are, we chase them.

Mrs. Rosie Barnes: Will the Minister give way?

Mrs. Currie: No. I do not have time, because we have a long debate.
The hon. member for Peckham said that it will take five years to screen everyone. Of course it will. If the hon. Lady is seriously suggesting that we call in millions of women next week all at one go, then she is dimmer than I thought, or else she is deliberately attempting to mislead the women of this country. As she is a nice lady on the whole, I do not think that she is doing that. In any case, we need a steady throughput for the laboratories and, where necessary, the treatment centres. The same point has been made to us about the breast cancer programmes.
As for the hon. Lady's statement that some of district health authorities will not be screening, even in five years, I can say categorically that she is wrong. If she has any information to the contrary, I hope that she will tell me which health authorities are involved and I shall deal with them. I make that promise to the House.
I should like briefly to deal with the three-year interval. The new clause would set the recall interval at three years. We have told all health authorities that recall should be at least every five years. That was based on careful consideration of all the clinical and epidemiological data available.
A report by the International Agency for Research on Cancer, which was published in 1986, says that efficient five-yearly screening between the ages of 20 and 64 reduced the chances of a woman developing cervical cancer by 84 per cent. That is our target. It is also the advice which I received recently in Finland, which has had a five-yearly system for many years and has seen a sharp drop in its death rate.
If we were to move to a three-year system, the number of lives that might be saved would be very small. We want to save those lives as well, but, first, we are keen to save the 84 per cent. of lives that are achievable with five-yearly screening. That is our first target. We are already saving lives. We have said to those health authorities which are reaching a high proportion of eligible women regularly that they are free to increase the frequeny of the screening, and some of them have chosen to do so. That is why the revised guidance which we issued in January to the health authorities and the family practitioner committees said that recall should be at least every five years.
The hon. Member for Peckham, who I know is interested and concerned about this issue, should reflect on what would happen if we moved to a three-year system before we have achieved a high overall response. The keen women would come again and those women who are at


risk still would not come. 'That is what would happen. In my judgment, and in the judgment of our medical advisers, that is not the way to proceed.
The hon. Lady is concerned about take-up. So am I. She will see that we have set up the computer system so that we now get much better information on take-up. There has been mention of the quality of smear tests and of the reading of smears. Many of those points have been covered in the recent circular, a copy of which is in the Library.
We are also concerned about the training of staff. The training of staff is being carried forward. The hon. Lady might care to listen to the debate on clause 13 tomorrow for some interesting information.
The hon. Member for Lewisham, Deptford asked about spatulas. The Aylesbury spatula is available under the central supply arrangements. The Committee on Gynaecological Cytology will review all the spatulae and the brushes at its next meeting, which is in July. If necessary, the central supply arrangements can be adjusted in the light of its recommendations.

Ms. Harman: The Minister looks as though she is reaching her last page. I do not want her to sit down before she has answered my points about women in Liverpool who have suffered invasive cervical cancer, unless I am too dim to have noticed her reply. Incidentally, the last time the Minister said that I was too young to understand. Now, apparently, I am too dim. I await to hear the next reason why I cannot understand.

Mrs. Currie: All I can say to the hon. Lady is, if the cap fits, wear it.
We understand that some women in the Mersey area have started legal proceedings. Therefore, it would not be appropriate for me to comment at this stage.
Lastly, I should like to say that nobody need wait for the invitation. If a woman has never been screened or has not been screened for more than five years, or if she has any problems such as pain or discharge, she should go to her doctor now. If that eminently good advice were to be followed and if Opposition Members could possibly endorse it, we should save lots of lives.

Ms. Jo Richardson: I found the Minister's speech, delivered at a rate of knots, so complacent that it was breathtaking. She gave us a lot of interesting information, and I join her in one thing—in congratulating the people who have undertaken the massive job of computerisation. I do not know that they will thank her for her congratulations, because they had no funds with which to do it. They had to find the money by paring funds for other essential services. In the new clause, we are emphasising the fact that the Government have to fund the health authorities to enable them to provide this essential service.
The hon. Member for Portsmouth, North (Mr. Griffiths) also took my breath away when he said that the best way to deal with the problem was to let women look after themselves and not to worry about calling them in: at least that seemed to be the import of what he said. I have to tell him that that would not cut the death rate, but would increase it. Women cannot always get the service that they require when they want it, even if they go for it. I think the hon. Gentleman said that students might take advantage of the system. Many health authorities do not screen women before the age of 35.

Mr. Peter Griffiths: I was not suggesting that students need to be tested. My suggestion was that the process of education should begin at school and in college, to remind women of their obligation to supplement the system by their own responsibility.

Ms. Richardson: Obviously I misunderstood the hon. Gentleman slightly. Nevertheless, the point he was making stands—that women should start thinking for themselves. That would be fine if the service was provided in all the regions by the family practitioner committees and if there were well women clinics in every hospital to deal with it. If that were the case, I would accept it.
Our new clause responds to current epidemiological evidence and to the recommendations to the Department of Health and Social Security from the British Medical Association's medical services committee. The BMA says
that the introduction of an adequately funded cervical cytology programme which offers a cervical smear test to women over the age of 20 at three-yearly intervals, together with adequate follow-up facilities"—
that is very important—
comparable with those of many other countries, would indicate the determination of the Department of Health to reduce significantly the numbers of deaths each year from cervical cancer.
The Minister has had an opportunity tonight to demonstrate that determination but, sadly for thousands of women, I think that she has shown, despite the information that she has been given, a terrifying complacency that will not satisfy them. From all that has been said, it is clear that the present highly unsatisfactory and, indeed, dangerous, situation is to be allowed to continue.

Mr. Nigel Spearing: My hon. Friend will know that, although strapped for cash, Newham district health authority has made great strides in this respect. To take up my hon. Friend's point about the BMA, has she noted that the Minister said that a three-yearly test would save a few more lives, but that she does not intend to accept our new clause because, although she has not spelt it out, it would cost too much money? If that is not the reason, I hope that my hon. Friend will invite the Minister to get up and say why she does not accept our new clause.

Ms. Richardson: My hon. Friend has made the point. I should be happy for the Minister to intervene and answer him, and I invite her to do so, but the Government are not prepared to fund such a scheme. It is all very well for the Minister and others to say that some lives will be saved in this way, but it will not be all that many. One life is worth saving. We should not fall into the trap of saying that if there are tests for 83 per cent. it does not matter about the remaining 17 per cent.
Arrangements for screening of cervical cancer, which claimed the lives of 2,203 women in 1986, vary widely. The survey carried out by my hon. Friend the Member for Peckham (Ms. Harman) confirmed that, seven years after the recommendation of the Government's own expert committee, lack of money has prevented health authorities from carrying out the committee's advice. More than half the 81 districts due to set up computerised programmes are offering only five-yearly screening. Virtually all are imposing varying upper age limits—from 55 years to 60, 64 or 65 years. Again I refer to what the hon. Member for


Portsmouth, North said. If a woman is 56 years old, she might find that she cannot be tested because in her health authority area screening stops at 55.
The Minister recently sent a letter to all Members of Parliament on this topic. What she said in her letter has been exposed by my hon. Friend's survey and by the BMA. I quote again from the BMA, because what it says is very important, and the BMA is usually influential in this House. It said:
At present arrangements for screening in health authorities vary widely. Some authorities have introduced programmes based on three-yearly intervals, whereas laboratories in others are refusing to accept specimens more frequently than five years. This is confusing for the public and creates difficulties for doctors in their relationships with patients … Optional flexibility and lack of clear guidance on the nature of local programmes are guaranteed to make matters worse.
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I recall the 'sisterly warning' that I gave the Minister when she announced her "special responsibility" for women's health. I warned her then that women would not take kindly to sensationalism and publicity stunts in place of well-thought-out policies to improve women's health care. I am pleased that since that time we appear to have won the Minister, at least in word, away from her previously held view—not all that long ago, I remind her—that universal screening was neither desirable or effective. However, in deed, I am sad to say, she has been a sensational flop in securing and directing the resources that are needed for a safe, secure, nationwide call and recall system. She has also, unfortunately, shown a gross insensitivity, in my opinion, to women's well-founded anxieties about some of her pronouncements.
Recently the Minister told women not to "sleep around". I do not think that those were the words she used, but, whatever the words, that is not the way to address the problem. That is no way to speak to women, of any age, about their personal sexual relationships. The Minister grins broadly, but I do not think that women take very kindly to such slighting remarks. The Minister should be aware by now of the fact that no one knows exactly the cause of cervical cancer.
Although there is some evidence to suggest that there may be a connection between a wart virus passed on during sexual intercourse and cervical cancer, or having sex at a very early age or with several partners, the Minister must remember that only a tiny proportion of women who started having sex at a young age, or who have had many partners, develop cervical cancer. Many women who develop cervical cancer have had only one partner.
Such so-called advice is an insult to women and a cheap cover-up by attempting to blame the victims for the Government's abject failure to give a clear lead in providing both the resources and the statutory obligation to provide three-yearly screening on a call and recall basis.
The fact is that 96 per cent. of cases that are caught at the pre-cancer stage are curable by laser treatment. The remainder can be cured by other treatment. I refer to a letter that I received recently from a 29-year-old woman in south Devon. She has been able to have regular smear tests because, as she says, she is articulate and able to insist upon her rights, though she does not know whether that applies to other women in her own region or in other

regions. She has had abnormal results which at first were regarded as an infection and treated as such, but a few months ago the problem was classified as dysplasia, pre-cancerous cells.
She was referred to the colposcopy clinic at Torbay hospital and it was confirmed that she should have laser treatment. However, the laser equipment was broken, and it had been broken for some time. She was told by her consultant gynaecologist that there was no prospect of the laser equipment being repaired. That equipment had been donated by the league of friends of the hospital, which had raised the money for it. A trust had been set up to provide money for the maintenance of the laser equipment, but the money has run out.
That young woman wants to know what the Minister intends to do about that equipment. I shall send the Minister that letter, from which she will see that it is a very sad case. If hospitals have to be supplied with laser equipment and other equipment after raising money by jumble sales and coffee mornings, that is not our idea of a National Health Service, and that is not the way to save lives.

Mr. Michael Jack: I have here a copy of the West Lancashire Evening Gazette, in which one of the local journalists talks bravely about her exceedingly successful treatment for cervical cancer. I hope that we are not going to start trading blows. The hon. Lady has cited a problem. I am equally able to cite a success for our system.

Ms. Richardson: I am glad to hear of the hon. Gentleman's success story. I only wish that there were Success stories everywhere. I do not say that there are not many of them, but my point is that we must not allow any cases to be failures. It is no good saying that, because we have so many successes, a few failures do not matter. That is not the way to deal with women's lives.
For the Government to plead that they cannot spare more money in the regions for this specific purpose is rubbish. For them to give away £2 billion in tax cuts to the richest—funding them with social security cuts that take £1 billion from the poorest—and then refuse to implement the kind of scheme that we put in is unforgivable.
The Government are constantly crowing that the economy is booming and have shown themselves more than ready to legislate to increase and enforce central Government control where it is neither welcome nor beneficial. Yet they refuse every opportunity to legislate and give a clear commitment and direction where the demand and need for action on cervical cancer screening are glaringly clear.
I invite my hon. Friends, and challenge Conservative Members, to join me in support of new clause 1.

Question put, That the clause be read a Second time:—

The House divided: Ayes 205, Noes 279.

Division No. 255]
[8.50 pm


AYES


Abbott, Ms Diane
Beckett, Margaret


Allen, Graham
Beggs, Roy


Alton, David
Beith, A. J.


Archer, Rt Hon Peter
Bell, Stuart


Ashley, Rt Hon Jack
Benn, Rt Hon Tony


Ashton, Joe
Bennett, A. F. (D'nt'n &amp; R'dish)


Banks, Tony (Newham NW)
Bermingham, Gerald


Barnes, Harry (Derbyshire NE)
Bidwell, Sydney


Barnes, Mrs Rosie (Greenwich)
Boateng, Paul






Boyes, Roland
Hoyle, Doug


Bradley, Keith
Hughes, John (Coventry NE)


Bray, Dr Jeremy
Hughes, Robert (Aberdeen N)


Brown, Gordon (D'mline E)
Hughes, Simon (Southwark)


Brown, Nicholas (Newcastle E)
Illsley, Eric


Brown, Ron (Edinburgh Leith)
Janner, Greville


Bruce, Malcolm (Gordon)
Jones, Barry (Alyn &amp; Deeside)


Buchan, Norman
Jones, leuan (Ynys Mon)


Buckley, George J.
Jones, Martyn (Clwyd S W)


Caborn, Richard
Kaufman, Rt Hon Gerald


Callaghan, Jim
Kilfedder, James


Campbell, Menzies (Fife NE)
Kinnock, Rt Hon Neil


Campbell, Ron (Blyth Valley)
Kirkwood, Archy


Campbell-Savours, D. N.
Lambie, David


Canavan, Dennis
Leadbitter, Ted


Carlile, Alex (Mont'g)
Leighton, Ron


Cartwright, John
Lewis, Terry


Clark, Dr David (S Shields)
Litherland, Robert


Clarke, Tom (Monklands W)
Livsey, Richard


Clay, Bob
Lloyd, Tony (Stretford)


Clelland, David
Lofthouse, Geoffrey


Clwyd, Mrs Ann
Loyden, Eddie


Cohen, Harry
McAllion, John


Cook, Frank (Stockton N)
McAvoy, Thomas


Cook, Robin (Livingston)
McCartney, Ian


Cousins, Jim
Macdonald, Calum A.


Cox, Tom
McFall, John


Crowther, Stan
McKay, Allen (Barnsley West)


Cummings, John
McKelvey, William


Cunliffe, Lawrence
McLeish, Henry


Cunningham, Dr John
McTaggart, Bob


Dalyell, Tam
McWilliam, John


Darling, Alistair
Madden, Max


Davies, Rt Hon Denzil (Llanelli)
Mahon, Mrs Alice


Davies, Ron (Caerphilly)
Marek, Dr John


Dewar, Donald
Marshall, David (Shettleston)


Dixon, Don
Marshall, Jim (Leicester S)


Dobson, Frank
Martin, Michael J. (Springburn)


Doran, Frank
Martlew, Eric


Douglas, Dick
Maxton, John


Duffy, A. E. P.
Meacher, Michael


Dunnachie, Jimmy
Michie, Bill (Sheffield Heeley)


Dunwoody, Hon Mrs Gwyneth
Michie, Mrs Ray (Arg'l &amp; Bute)


Eadie, Alexander
Milian, Rt Hon Bruce


Eastham, Ken
Mitchell, Austin (G't Grimsby)


Ewing, Mrs Margaret (Moray)
Molyneaux, Rt Hon James


Fatchett, Derek
Moonie, Dr Lewis


Fearn, Ronald
Morgan, Rhodri


Field, Frank (Birkenhead)
Morley, Elliott


Fields, Terry (L'pool B G'n)
Morris, Rt Hon J. (Aberavon)


Flynn, Paul
Mowlam, Marjorie


Foot, Rt Hon Michael
Mullin, Chris


Forsythe, Clifford (Antrim S)
Murphy, Paul


Fraser, John
Oakes, Rt Hon Gordon


Fyfe, Maria
O'Brien, William


Galbraith, Sam
O'Neill, Martin


Galloway, George
Orme, Rt Hon Stanley


Garrett, John (Norwich South)
Parry, Robert


George, Bruce
Patchett, Terry


Gilbert, Rt Hon Dr John
Pendry, Tom


Godman, Dr Norman A.
Pike, Peter L.


Golding, Mrs Llin
Powell, Ray (Ogmore)


Gould, Bryan
Prescott, John


Graham, Thomas
Quin, Ms Joyce


Grant, Bernie (Tottenham)
Randall, Stuart


Griffiths, Nigel (Edinburgh S)
Redmond, Martin


Griffiths, Win (Bridgend)
Reid, Dr John


Grocott, Bruce
Richardson, Jo


Hardy, Peter
Roberts, Allan (Bootle)


Harman, Ms Harriet
Robertson, George


Hattersley, Rt Hon Roy
Robinson, Geoffrey


Haynes, Frank
Rogers, Allan


Heffer, Eric S.
Rooker, Jeff


Henderson, Doug
Ross, Ernie (Dundee W)


Hinchliffe, David
Ross, William (Londonderry E)


Hogg, N. (C'nauld &amp; Kilsyth)
Rowlands, Ted


Home Robertson, John
Ruddock, Joan


Hood, Jimmy
Salmond, Alex


Howarth, George (Knowsley N)
Sedgemore, Brian


Howells, Geraint
Sheerman, Barry





Sheldon, Rt Hon Robert
Wallace, James


Shore, Rt Hon Peter
Walley, Joan


Short, Clare
Wardell, Gareth (Gower)


Skinner, Dennis
Wareing, Robert N.


Smith, C. (Isl'ton &amp; F'bury)
Welsh, Andrew (Angus E)


Snape, Peter
Welsh, Michael (Doncaster N)


Soley, Clive
Williams, Rt Hon Alan


Spearing, Nigel
Williams, Alan W. (Carm'then)


Steel, Rt Hon David
Wilson, Brian


Stott, Roger
Winnick, David


Strang, Gavin
Worthington, Tony


Taylor, Mrs Ann (Dewsbury)



Taylor, Matthew (Truro)
Tellers for the Ayes:


Turner, Dennis
Mr. Alun Michael and


Walker, A. Cecil (Belfast N)
Mr. Allen Adams.


Wall, Pat





NOES


Alison, Rt Hon Michael
Dover, Den


Allason, Rupert
Dunn, Bob


Amess, David
Durant, Tony


Amos, Alan
Emery, Sir Peter


Arbuthnot, James
Evans, David (Welwyn Hatf'd)


Arnold, Jacques (Gravesham)
Fallon, Michael


Arnold, Tom (Hazel Grove)
Farr, Sir John


Ashby, David
Favell, Tony


Aspinwall, Jack
Field, Barry (Isle of Wight)


Atkinson, David
Fookes, Miss Janet


Baker, Rt Hon K. (Mole Valley)
Forman, Nigel


Banks, Robert (Harrogate)
Forsyth, Michael (Stirling)


Batiste, Spencer
Forth, Eric


Bellingham, Henry
Fowler, Rt Hon Norman


Bennett, Nicholas (Pembroke)
Fox, Sir Marcus


Benyon, W.
Franks, Cecil


Bevan, David Gilroy
Freeman, Roger


Biggs-Davison, Sir John
Fry, Peter


Blackburn, Dr John G.
Gale, Roger


Blaker, Rt Hon Sir Peter
Gill, Christopher


Body, Sir Richard
Glyn, Dr Alan


Bonsor, Sir Nicholas
Goodlad, Alastair


Boswell, Tim
Goodson-Wickes, Dr Charles


Bottomley, Peter
Gorman, Mrs Teresa


Bowden, Gerald (Dulwich)
Gorst, John


Bowis, John
Gow, Ian


Boyson, Rt Hon Dr Sir Rhodes
Gower, Sir Raymond


Brandon-Bravo, Martin
Grant, Sir Anthony (CambsSW)


Brazier, Julian
Greenway, Harry (Ealing N)


Bright, Graham
Greenway, John (Ryedale)


Brittan, Rt Hon Leon
Gregory, Conal


Brown, Michael (Brigg &amp; Cl't's)
Griffiths, Sir Eldon (Bury St E')


Bruce, Ian (Dorset South)
Griffiths, Peter (Portsmouth N)


Buchanan-Smith, Rt Hon Alick
Grist, Ian


Burns, Simon
Ground, Patrick


Burt, Alistair
Grylls, Michael


Butler, Chris
Hamilton, Hon Archie (Epsom)


Butterfill, John
Hampson, Dr Keith


Carlisle, Kenneth (Lincoln)
Hanley, Jeremy


Carrington, Matthew
Hannam, John


Carttiss, Michael
Hargreaves, A. (B'ham H'll Gr')


Cash, William
Hargreaves, Ken (Hyndburn)


Chope, Christopher
Harris, David


Churchill, Mr
Haselhurst, Alan


Clark, Dr Michael (Rochford)
Hawkins, Christopher


Clarke, Rt Hon K. (Rushcliffe)
Hayes, Jerry


Colvin, Michael
Heathcoat-Amory, David


Conway, Derek
Heddle, John


Coombs, Anthony (Wyre F'rest)
Hicks, Mrs Maureen (Wolv' NE)


Coombs, Simon (Swindon)
Hicks, Robert (Cornwall SE)


Cope, John
Higgins, Rt Hon Terence L.


Cormack, Patrick
Hind, Kenneth


Couchman, James
Hogg, Hon Douglas (Gr'th'm)


Cran, James
Holt, Richard


Currie, Mrs Edwina
Hordern, Sir Peter


Davies, Q. (Stamf'd &amp; Spald'g)
Howard, Michael


Davis, David (Booth ferry)
Howarth, Alan (Strat'd-on-A)


Day, Stephen
Howe, Rt Hon Sir Geoffrey


Devlin, Tim
Howell, Ralph (North Norfolk)


Dickens, Geoffrey
Hughes, Robert G. (Harrow W)


Dorrell, Stephen
Hunt, David (Wirral W)


Douglas-Hamilton, Lord James
Hunt, John (Ravensbourne)






Hurd, Rt Hon Douglas
Patten, John (Oxford W)


Irvine, Michael
Pawsey, James


Irving, Charles
Peacock, Mrs Elizabeth


Jack, Michael
Porter, Barry (Wirral S)


Jackson, Robert
Porter, David (Waveney)


Janman, Tim
Portillo, Michael


Jessel, Toby
Powell, William (Corby)


Johnson Smith, Sir Geoffrey
Price, Sir David


Jones, Gwilym (Cardiff N)
Raffan, Keith


Jones, Robert B (Herts W)
Rathbone, Tim


Jopling, Rt Hon Michael
Redwood, John


Kellett-Bowman, Dame Elaine
Rhodes James, Robert


Key, Robert
Riddick, Graham


King, Roger (B'ham N'thfield)
Ridley, Rt Hon Nicholas


King, Rt Hon Tom (Bridgwater)
Rifkind, Rt Hon Malcolm


Kirkhope, Timothy
Roberts, Wyn (Conwy)


Knapman, Roger
Roe, Mrs Marion


Knight, Greg (Derby North)
Rossi, Sir Hugh


Knowles, Michael
Rost, Peter


Knox, David
Rowe, Andrew


Lamont, Rt Hon Norman
Ryder, Richard


Lang, Ian
Sackville, Hon Tom


Lawrence, Ivan
Sainsbury, Hon Tim


Lee, John (Pendle)
Sayeed, Jonathan


Lennox-Boyd, Hon Mark
Scott, Nicholas


Lester, Jim (Broxtowe)
Shaw, David (Dover)


Lightbown, David
Shaw, Sir Giles (Pudsey)


Lilley, Peter
Shaw, Sir Michael (Scarb')


Lloyd, Sir Ian (Havant)
Shephard, Mrs G. (Norfolk SW)


Lloyd, Peter (Fareham)
Shepherd, Richard (Aldridge)


Lord, Michael
Sims, Roger


Luce, Rt Hon Richard
Smith, Sir Dudley (Warwick)


Lyell, Sir Nicholas
Smith, Tim (Beaconsfield)


McCrindle, Robert
Soames, Hon Nicholas


Macfarlane, Sir Neil
Spicer, Sir Jim (Dorset W)


MacKay, Andrew (E Berkshire)
Stanbrook, Ivor


Maclean, David
Stanley, Rt Hon John


McLoughlin, Patrick
Stern, Michael


McNair-Wilson, Michael
Stevens, Lewis


(Newbury)
Stewart, Allan (Eastwood)


McNair-Wilson, Patrick (New Forest)
Stewart, Ian (Hertfordshire N)



Stokes, John


Madel, David
Sumberg, David


Major, Rt Hon John
Summerson, Hugo


Malins, Humfrey
Tapsell, Sir Peter


Mans, Keith
Taylor, Ian (Esher)


Maples, John
Taylor, John M (Solihull)


Marlow, Tony
Taylor, Teddy (S'end E)


Marshall, John (Hendon S)
Tebbit, Rt Hon Norman


Martin, David (Portsmouth S)
Temple-Morris, Peter


Mates, Michael
Thompson, D. (Calder Valley)


Maude, Hon Francis
Thompson, Patrick (Norwich N)


Mawhinney, Dr Brian
Thurnham, Peter


Maxwell-Hyslop, Robin
Townsend, Cyril D. (B'heath)


Mayhew, Rt Hon Sir Patrick
Tracey, Richard


Mellor, David
Tredinnick, David


Meyer, Sir Anthony
Trotter, Neville


Miller, Hal
Twinn, Dr Ian


Mills, Iain
Vaughan, Sir Gerard


Mitchell, Andrew (Gedling)
Waddington, Rt Hon David


Monro, Sir Hector
Wakeham, Rt Hon John


Moore, Rt Hon John
Walden, George


Morris, M (N'hampton S)
Walker, Bill (T'side North)


Morrison, Hon Sir Charles
Waller, Gary


Moss, Malcolm
Walters, Dennis


Neale, Gerrard
Ward, John


Neubert, Michael
Wardle, Charles (Bexhill)


Newton, Rt Hon Tony
Warren, Kenneth


Nicholls, Patrick
Wells, Bowen


Nicholson, David (Taunton)
Wheeler, John


Nicholson, Emma (Devon West)
Whitney, Ray


Onslow, Rt Hon Cranley
Widdecombe, Ann


Oppenheim, Phillip
Wiggin, Jerry


Page, Richard
Wilshire, David


Paice, James
Winterton, Mrs Ann


Patnick, Irvine
Winterton, Nicholas


Patten, Chris (Bath)
Wolfson, Mark





Wood, Timothy
Tellers for the Noes:


Woodcock, Mike
Mr. Robert Boscawen and


Younger, Rt Hon George
Mr. Tristan Garel-Jones.

Question accordingly negatived

New Clause 2

PROVISIONS AS TO MERIT AWARDS

'Consultants holding maximum part-time contracts, and, undertaking private work, shall not be eligible for distinction and meritorious service awards.'.—[Mr. Robin Cook.]

Brought up, and read the First time.

Mr. Galbraith: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Sir Paul Dean): Order. I am reminded that the hon. Gentleman has not put his name to the new clause. Will an hon. Member whose name is on it please move it formally?

Mr. Robin Cook: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker: With this it will be convenient to take new clause 3—Private work by National Health Service consultants—
'A consultant holding a whole-time National Health Service contract shall not undertake private work and any consultant who undertakes private work shall be deemed to be holding a part-time contract and his remuneration be adjusted accordingly.'.

Mr. Galbraith: I apologise for that slight technical hitch. It is typical of the inefficiency in some hospital operating theatres.
In speaking to the clause, I do not want to be seen as making an attack on doctors and members of the medical profession, some of whom remain my good friends despite many of the things that I have said about them in the past. It is an attack on certain doctors and, in particular, on some practices in the medical profession that have been encouraged by the Government, particularly in respect of part-time consultants and the abuses of private practice.
I believe that my comments will gain all-party support. I note that even the hon. Member for Darlington (Mr. Fallon) wrote on this matter in the The Guardian of 17 February. He said:
Porters, cooks and cleaners have been obliged to lay their jobs on the line. But in nine years of radical Thatcherism whoever heard of a consultant sacked for inefficiency?
We shall be talking about merit awards, private practice and efficiency. Opposition Members have been talking about inefficiency for a number of years, but the Government have only recently discovered it. They have discovered it not for its benefits, but as an excuse so that they can say that the problems in the Health Service are the fault of someone else, rather than because they have underfunded the Health Service. They have been looking around for scapegoats.
I wish to speak first about merit awards. They have all-party support. The hon. Member for Surrey, South-West (Mrs. Bottomley) asked a question about merit awards. She asked:
Does the Secretary of State agree that with more than 6,000 merit awards now being paid annually and with the top award being worth more than £27,000, thus virtually doubling a consultant's pay, it is in the interests of the public, the patients and the profession that more information should be readily available? It is time for people to know the by whom,


the to whom, the how and the why of merit awards. That would end the secrecy and suspicion."—[Official Report, 10 February 1987; Vol. 110, c.144.]
Opposition Members wish to echo those sentiments and to develop them at this stage.
Merit awards go back to the inception of the Health Service and were set up as a result of the Spens committee, which argued that merit awards were required
if the recruitment and status of specialist practice are to be maintained, specialists must be able to feel that more than ordinary ability and effort receive an adequate reward
and that
any satisfactory system of remuneration must involve differentiation dependent on professional distinction".
Four types of merit awards are given, in addition to the consultant's salary, which currently stands at £32,000 per annum. There is a C merit award of £5,790, a B merit award of £13,000, an A merit award of £22,750 and an A-plus merit award of £29,550, virtually doubling a consultant's salary.
About one third of all consultants receive those awards, but there are two important factors to consider in respect of their distribution. First, very few women receive them. Women are particularly discriminated against because of the nature and secrecy of the committee.

Mr. Robin Cook: That includes my wife.

Mr. Galbraith: I never received a merit award either, when I was working as a consultant.
The merit awards are concentrated on the high-profile, high-tech branches. In my unit, there was a 60 per cent. uptake of merit awards. At one time, 12 out of 14 consultants had a merit award. Cardiothoracic surgery received 50 per cent. of the awards. I was disappointed that, even with my considerable distinction, the committee felt that it could not give me an award at that stage.
The problem is that, in some important specialties which do not have such a high profile, fewer people receive awards. For example, in occupational medicine, only 7 per cent. of the profession receive merit awards. There is a bias against certain specialties in favour of others, depending on the nature of the committee. That bias is inherent in the structure and it is self-perpetuating.
The structure hands out £60 million of taxpayers' money a year, yet we know very little about it. People have asked me about the merit awards system. I have been asked who gives out the awards and I have had to reply that I do not know. I have some vague idea that one or two people may be involved, but I am not sure. I have also been asked who receives the awards, and again I have had to reply that I do not know. Slight changes have been made recently and we can find out from the health board who receives the awards, but it is very difficult for the public to discover what is happening. I have also been asked why people receive the awards and what meritorious work has to be carried out. Again, I have to reply that I do not know. Therefore, £60 million of taxpayers' money is handed out by people we do not know to people we do not know for reasons that are not clear to anyone.
Reasons have been given for the granting of the awards. A statement appears in the Official Report on 4 November 1983, stating that the reasons for granting the awards include:
direct service to patients or their general practitioners, improvement of the service, training and teaching research, medical administration, and clinical or academic distinction.

Hard work and outstanding service to the NHS may alone be sufficient reason for an award, particularly at the B and C levels."—[Official Report, 4 November 1983; Vol. 47, c. 487.]
Although we may accept that numerous members of the profession who may or may not fulfil the criteria for merit awards actually receive them, we recognise that many people clearly do not deserve the awards. The reason why they have obtained awards, to which they are clearly not entitled, is that the awards are granted by a secretive system run by a small band of men. That is a form of patronage.
I remember that the system was used as a form of patronage. There was always a godfather figure in the region who controlled the system and the money. That medical godfather dispensed patronage. At the end of the day he decided whether someone received a merit award, depending on whether or not that person had been a good boy and supported the various ideas which the godfather wanted to propagate.
The merit awards are given for life. At the age of 40, on a salary of £32,000, someone may receive a top-up award of £11,000 or £12,000 for life. It does not matter whether that someone continues to fulfil the meritorious standards to retain the award. Reform must be made. How can we continue to dispense £60 million of taxpayers' money for life when there is no system of control?
I am not alone in believing that there is need for reform. Many members of the medical profession believe that there should be reform. Most members of the profession agree that the merit award system needs to be reformed, although they may not all necessarily agree on the precise need.
New clause 2 contains our proposals for reforming the merit award system. The awards should be limited to those working full-time for the National Health Service. Only those people perform meritorious work and behave with distinction sufficient to merit the awards. We want the Government to consider our proposal.
The awards were originally granted at the inception of the National Health Service to encourage members of the profession to stay within the NHS and not to practise privately. We want to return to that original reason and ensure that the merit awards are given only to full-timers in the NHS. I know that they are given pro rata to part-timers who fill in, but we want the awards to be granted only to full-timers.
I have the support of Professor David Anderson, the professor of endocrinology at the university of Manchester. He described the system as "patently indefensible". He said:
We all know consultans who work incredibly hard for the NHS who do not have an award, or only a low-grade one, while others whose commitment is not what it was continue to enjoy higher awards.
Therefore, we are asking the Government to review the merit award system and to accept our new clause, which seeks to ensure that these awards will be made available only to full-time consultants.
9.15 pm
We would also like merit awards to be reviewed every five years. It is incredible that one can be given this large amount, often doubling one's salary, yet it never again comes up for review. It is vital that, if the awards are to be be retained, they should be reviewed every five years.
It is also important—the Minister may wish to reply to this as well—that all those considered for merit awards are


told of this consideration and that, if they do not receive an award, the reason is published. If doctors are failing to improve their standards or are developing their efficiency and doing new things, that would be a useful check. At present one cannot find out whether one has been considered, other than by devious means. It would therefore be an advantage to know whether one was being considered, and, if turned down, to be given the reason why.
New clause 3 deals with the question of private practice in the National Health Service, the contract and the question of full-timers doing private practice. The contract was changed by the Government in 1980. One of the first things that they did was to take the consultant contract from what was full-time and maximum part-time—nine-elevenths—and to give the maximum part-timers ten-elevenths and allow those who worked full-time to do private practice.
We wish to reverse that. We want a full-time consultant to remain a full-time consultant and not be allowed to do private work.
The change in contract was introduced by the Government, who now complain about the amount of private practice done by consultants. Perhaps they may like to reflect on that every time they hold up the consultants as the reason for the problems in the National Health Service. When they introduced the change in 1980, the Government said that it was for the effective functioning of the hospital service that consultants should feel that they were fairly treated and that their contributions were appreciated and adequately valued. In making the offer, the Government sought to translate this into action. The Minister made what was described as "an imaginative gesture" to consultants, clearly believing that its effect upon morale could only redound to the advantage of the National Health Service and its patients.
That was the comment at the time the Government changed the system and allowed full-timers to do private practice. Opposition Members pointed out that consultants would shift their bias towards private practice, to the detriment of the National Health Service, and campaigned against the move. To counter that, the Government decided to introduce six principles—these "paper principles" that no one really believed in and no one bothered about. But we predicted that, even with the principles, the National Health Service would be damaged. No, said the Government. Yet we find that, come the end of last year, the Government once again believe what we say.
Have the Government changed their mind? I read from The Independent of 14 December:
The Downing Street attack came as Mrs. Thatcher, who has a network of Conservative doctors"—
that would not be difficult—
who brief her independently of official channels, was told last week that hospitals could be 15 to 20 per cent. more efficient if consultants who did private work in NHS time, or spent unnecessary time on committees … were brought to heel.
How interesting—the very thing that we were talking about in 1980 when the Government changed the contract. Suddenly we find that the Government agree with what we said then.
On 13 December there was a series of articles in The Sunday Times, planted by the Government, developing that theme. On the front page it said:
Thatcher rounds on top doctors.
There was nothing about remunerating them well or about increased morale reflecting on the Health Service and developing it, as there had been in 1980.
Thatcher rounds on top doctors.
It sends shivers down my spine.
At the bottom of the article, it talks of
spending time in Harley Street, 'or wherever', while their clinics and operating lists are looked after by unsupervised junior staff.
Those are the things that Opposition Members talked about and campaigned against for many years. The Government are suddenly agreeing with us. What has happened to cause that change of heart by the Government?
Another theme that has been developed by the National Audit Office is inefficiency in the provision of services. The Sunday Times reported:
Inefficiency played a large part in this because of the inadequate forward planning of admissions"—
"this" is the misuse, the under-use, the 50 per cent. use, of operating theatres—
lack of coordination between hospital departments, and last-minute cancellations of operations due to the absence of medical staff.
How surprising. Those are the things that we were talking about in 1980, but we were told to go away, that our fears were silly and that such a situation would never happen because doctors could be trusted, being highly professional members of society. I remember being told to stop casting scurrilous slurs on the medical profession. However, suddenly we find:
Thatcher rounds on top doctors.
What has suddenly happened? Perhaps the Minister will explain it.

Mr. Graham Allen: The Public Accounts Committee has considered the report of the National Audit Office on the use of operating theatres. In one district health authority, there was 50 per cent. under-use of operating theatre time, half of which was because of cancellations by anaesthetists and consultants, not because of misallocation or mismanagement, but purely because of those people not turning up or not wishing to carry out those operations. It was suggested in Committee that a possible reason was that they were going down the road to do private work.

Mr. Galbraith: There is no question but that that is the reason. I have experience of many lists being cancelled, not always because of the surgeon, but because of the anaesthetist also. We must include the anaesthetist in the equation. As a junior doctor, I had experience of patients being on the operating table, anaesthetised, waiting for the surgeon to come from a private clinic. That is not unusual.
We predicted all those things when the contract was changed in 1980. We are now seeing them come to fruition, but it is interesting that the Government admit to the problem. They will be keen to accept our new clause 3 so that we can get back to the position that existed before 1980. It is the fact that surgeons perform private work that leads to poor use and inefficiency in the provision of services.
If one is a full-timer, one is always there and available to do things as they arise. One is always there to see the


X-rays as they are produced, and to see the patients. One produces an efficient service by always being there, fitting into slots that become available. However, if one has a private practice commitment, certain sessions are immediately taken up and shifted aside, and it is impossible to be efficient.
Let us consider a parallel. We have a National Health Service in which we allow some doctors to work as private contractors. Let us consider what would happen if we allowed airline pilots to do the same. Let us imagine that we turn up for the British Airways shuttle at London Heathrow, only to find that it has been cancelled, just like an operation, because the pilot has decided to fly for British Midland Airways Ltd. that morning. He probably took the British Airways shuttle with him without telling anyone. That is an absolute parallel—[Interruption.] Yes, or teachers. They are the same, but they would take the blackboard with them.
The argument for allowing more private practice was that it would help to reduce waiting lists. It was said that people going into private care would help to reduce waiting lists. There was no evidence whatsoever of that, and there has been no evidence since. Indeed, waiting lists have increased. However, that was the argument. That is similar to the argument that if a large queue is waiting for a bus and a taxi comes along and someone gets in the taxi, the queue becomes smaller. However, they do not realise that there is a large queue for a bus in the first place because the person who is supposed to be driving the bus is moonlighting and driving the taxi. That is the problem that we face with private practice in the National Health Service.
I am glad that the Government see the problems that they generated when they changed the contract in the 1980s. They accept that the contract produces inefficiency and encourages absence from the NHS. I hope that they will accept new clause 2, which deals with merit awards, and new clause 3. The system must be overhauled in the interests of fairness, equity and open government.

Mrs. Gillian Shephard: We have had a riveting expos? of the more arcane features of the merit award system and the functioning of consultants in hospitals from one who knows, in the person of the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). I only hope, for his sake, that he is not ill in the next week or two.
I hope that my right hon. Friend will keep the matters under review in the regular discussions he has with the presidents of the royal colleges. In those discussions he should continue to consider the equally important question which impinges directly on the efficiency and effectiveness of consultants and their involvement in local management processes: that is, the question of their contracts being held at district level. The excuse that is usually given for this not being considered is that many consultants work for several districts. That is hardly an important reason, since the number of such consultants is not known by the DHSS, as I elicited through a parliamentary question not long ago.
In the regular discussions and consultations that my right hon. Friend has with the royal colleges, he should consider not only the points that were made by the hon. Member for Strathkelvin and Bearsden, but also a change in where consultants' contracts are held, because it would contribute greatly to the efficiency of the service if their accountability lay where their work is.

Mr. Newton: In responding to the debate, I can most easily indicate my general approach by saying a word first about what my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard) said about the point at which consultants' contracts are held, because it will cover the generality of the thrust of my reply, which is that we are always prepared to keep these matters under review. I noted with great interest the suggestions that were made by the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) and by my hon. Friend.
I shall also take such steps as I can to ensure that the hon. Gentleman's remarks are drawn to the attention of his colleagues in the profession not in the spirit that my hon. Friend implied about what they might do to penalise him, should the occasion arise, but rather that they may reflect on those remarks.
I hope that the House will understand why I will comment on only one or two practical points rather than cover the full sweep of the hon. Gentleman's remarks. His proposed new clause 2 would exclude from the receipt of distinction awards all maxirnum part-time consultants, including those who carry out their contractual duties entirely properly and efficiently, while it would make no changes to the position of consultants holding other types of contracts. As he said, maximum part-time consultants are expected to devote substantially the whole of their professional time to their duties in the NHS and to have the same commitment to continuing patient care as whole-timers. That may include being available to give emergency cover at night and at weekends. This is more than a technicality, although I understand that it could be said to be a technicality.
If the new clause were adopted in its present form, the most likely outcome would be that most maximum part-timers would not become full-timers, but would change to nine-session part-time contracts to secure their right to be considered for distinction awards and to undertake unlimited private practice. The loser in that would almost certainly be the Health Service.

Mr. Robin Cook: I wish to clarify the terms of the new clause. As the Minister will be aware, its purpose is to bar from awards consultants holding maximum part-time contracts and undertaking private work. It is not our intention to bar from merit awards those consultants, albeit a minority, on maximum part-time, who become maximum part-timers for other reasons than a wish to carry out private work, such as female consultants who work as maximum part-timers because of family commitments. It is important that I put that on the record; otherwise I dare not go home at the weekend.

Mr. Newton: I should not want the hon. Members for Livingston (Mr. Cook) and for Strathkelvin and Bearsden to be persecuted by every doctor in Scotland.
The comments of the hon. Member for Livingston have left me in some slight difficulty, although I do not mind that. The difficulty is that the clauses are meant to be read together for what they are—two separate and distinct propositions. Unquestionably, the interpretation that I have just given is what new clause 2 states. The hon. Gentleman's interpretation relates to what would happen if new clause 2 and new clause 3 were amalgamated. Nevertheless, it does not significantly alter the point that I sought to make. Indeed, if anything, it may strengthen it.
If the position that would be created jointly by the two new clauses were brought about, and possibly by either of them separately, the most likely outcome would be the loss of several consultants to the Health Service or a diminution of their commitment to the Health Service by moving to part-time contracts of fewer sessions than are implied by a maximum part-time contract. I doubt whether that was intended, but it was reasonable for me to make that point.
9.30 pm
I am glad that the hon. Member for Livingston made his point. The tears that the hon. Member for Strathkelvin and Bearsden wept over the plight of women in relation to merit awards appeared to be crocodile tears, in the light of the rest of his proposition, which would certainly have made it much more difficult for women to receive merit awards.
In view of the time, the desire to make progress, and the slight confusion that has been created by the way in which the clauses were presented and the way in which they were represented, it is probably not sensible for me to say more except to repeat that I shall reflect on what has been said and ensure that, by various means, it is drawn to the attention of the professions, the advisory bodies and, indeed, the review body.

Question put and negatived.

New clause 5

GENERIC PRODUCTS

'(1) Where drugs, medicines or listed appliances are ordered by their brand name for a person by a medical practitioner in pursuance of his functions in the health service, the Scottish health service, the Northern Ireland health service or the armed forces of the Crown (excluding forces of a Commonwealth country and forces raised in a colony), it shall be the duty of the person supplying such drugs, medicines or appliances to supply a generic product approved by the Secretary of State instead of the product by its brand name.
(2) Subsection (1) above shall not apply where the person for whom the drugs, medicines or appliances are ordered requests the product to be supplied by its brand name, and in that case he shall pay any additional cost of such product in excess of the cost of the generic product.'.—[Mr. Wareing.]

Brought up, and read the First time.

Mr. Robert N. Wareing: I beg to move, That the clause be read a Second time.
When the Government talk about savings and value for money in the National Health Service, one aspect is conspicuous by its absence. Some may consider that it may have something to do with the old adage that he who pays the piper calls the tune. As we know, some pharmaceutical companies are adept at providing funds for the Tory party's election expenses. I wonder whether that motivates the Conservative party in relation to generic prescribing and generic substitution.
The essence of generic prescribing is that a doctor uses the approved name of a drug—that is to say, the accepted name of the chemical entity that makes up the drug. The purpose of new clause 5 is to ensure that, even if a general practitioner has prescribed a branded drug, it is possible and nearly always cheaper for a patient to be offered a

generic substitute. I should have thought that that would be in accordance with Government policy, as indeed it is in accordance with the Opposition's policy.
The National Health Service drugs bill is about £2 billion a year. That generic prescribing can bring about a reduction in that colossal figure is proven by the fact that, when the limited list that only partially involved generic prescribing was introduced, the Government were able to claim that £75 million was saved in the first year of operation. The Department of Health and Social Security already advises its general practitioners that they should look to generic prescribing, and hospitals generically prescribe for their patients as a matter of course.
We should be looking for real savings in prescribing. Such savings would benefit not only the Government in terms of public expenditure, but those patients who will be even more deprived as a result of many other aspects of the Government's policy, part of which we debated this afternoon. Anything that helps those patients in these days of higher prices in the National Health Service will be warmly received.
I shall not cite journals of the Labour movement, but the "Drug and Therapeutics Bulletin" of 30 November 1987 estimated that there could be an overall saving of £100 million to the National Health Service if generic substitution were introduced. That journal, worthy though it may be, was assuming that it would be non-mandatory generic substitution. Even more substantial benefits to the National Health Service in terms of cost-effectiveness could be achieved if the Government accepted the new clause. Incidentally, I was rather pleased that, although the Government did not accept new clause 2, there were signs that it did not entirely offend them. I hope that we shall fare as well with this new clause.
The savings would be very great. Let us consider the example of the antibiotic sold by Pfizer under the brand name Vibramycin. A bottle of 50 tablets of Vibramycin costs the patient and the National Health Service £23. Roxycycline, a generic substitute sold by Harris Pharmaceuticals, sells at £10 for 50 tablets. That represents a saving of £13 on every 50 tablets prescribed. It is not excessive to estimate that the overall savings to the National Health Service could be about £400 million if mandatory generic substitution was in operation. Let me give another example. A 100-pack of 100 mg Zyloric costs £16·13, but the generic Allopurinol costs £1·49. On that drug alone there is a saving of 90·7 per cent.—more than £10 million.
If the Government are looking for money for the National Health Service, there is no excuse. In the main, the drug companies—many of them foreign multinationals—are waxing very rich in relation to the National Health Service. I am glad to see Conservative Members nodding. I only wish that their nods were nods in the direction of the Aye Lobby. However, Conservative Members are very late learners; some of them had to wait until this afternoon to discover what was happening under other Government legislation.
It is very important that patients should have a clear idea of what is being prescribed for them. Under the present system of branded products, many different names are given to the same medicine. I am sorry that we are not able to debate the new clause about benzodiazepines. The most lethal of these is lorazepam, which comes either as Ativan produced by Wyeth or as Almazine produced by Steinhard. I wonder how many people who have been


prescribed Almazine knew that they were taking this potentially lethal drug which is exactly the same as Ativan, now going under the name of lorazepam.
The benzodiazepine called temazepam, which was prescribed last year over 7 million times at a cost to the National Health Service of more than £11 million, has all sorts of side and withdrawal effects that should be well known to many doctors. According to the British National Formulary, that drug can come in three different forms.
The Government were advised long ago in the Greenfield report of 1982 that generic substitution should he in operation in the National Health Service. Of course we know that the Government are deaf to advice, even from their own advisers. The report said:
We consider that many doctors would be quite content for their patients to receive an alternative version of the drug prescribed, but that they tend to prescribe the proprietory brand with which they are most familiar. We therefore suggest the introduction of a simple scheme which would require doctors to indicate a positive preference for the proprietory version by initialling a box provided for that purpose".
The report quite clearly approved of the whole idea of generic substitution. The then Minister for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), argued against that when he made a statement in the House in December 1983. His argument was not very convincing. Its crux appeared to be where he said:
The committee"—
that is, the Greenfield committee—
acknowledged that it had not taken account of the wider implications, for example on the pharmaceutical industry, of its recommendation."—[Official Report, 8 December 1983; Vol. 50, c. 474.]
The pharmaceutical industry does very well out of the National Health Service. I have yet to hear of one of the large pharmaceutical firms complaining that it is on the border of liquidation. As I have said, some of them can find extra funds to help to finance the Conservative party.
Real benefits can flow from generic prescribing, and that is why we should look for a positive means of giving the National Health Service a monetary boost by cutting its costs. Generic names show the chemical class to which drugs belong and that gives information about properties. Names such as Ativan and Valium do not give such information until it is too late and patients suddenly complain about side and withdrawal effects. Generic substitution would mean a single name and that would reduce the present confusion about the naming of drugs. Normal generic names are used in medical teaching and in medical bulletins, and should be well known to the medical profession.
One other economy for the Health Service would result from the economy to pharmacists. Instead of holding the very large stocks that they presently have to hold because of the large number of branded products, they would be able to reduce their stocks and costs. That in itself would be a saving, and costs would be cut all round. There are many arguments about what those costs would be. In answer to my hon. Friend the Member for Peckham (Ms. Harman), the Minister for Health said on 11 February that only 28 per cent. of prescriptions dispensed in Britain are generically dispensed. That was according to the figures for 1986. On the same day, the Minister said that the prescribing of all drugs generically would bring about a saving of about £35 million in England. Obviously it would he more if it included the United Kingdom as a whole.
9.45 pm
The Government all too often tell us that they believe in competition. We should ask ourselves what branded goods imply. Branded goods constitute a monopoly practice. They are a way of dividing the market between different consumers of essentially the same product. We have heard of that happening in many other respects. For example, it has happened with detergents. What the great monopolist cannot get with Omo he gets with Tide. The same principles apply to the pharmaceutical companies.
General practitioners in our urban areas are often overburdened and are pressurised by the ad-men into prescribing this or that branded product. All too often they have little time to consider the reality that lies behind brand X, brand Y or brand Z. If the Government's belief in abandoning restrictive practices is wider than their belief in simply abandoning those practices in the labour market, they should be looking to some of their friends in the pharmaceutical industry who could be providing a real service to the country by placing their goods on the market for what they are, by providing the public with real information about the chemical composition of a product and by ensuring that there is a cost advantage to the NHS.
It seems wrong for a Socialist to be telling Tories what to believe in. However, I strongly suspect that one of the factors behind the Government's thinking is that they dare not offend their monopolistic friends. There is no reason why they should be worried about that. We are not afraid to offend some of our friends when the occasion demands it. I see no reason why a Government as arrogant as this and with such a large majority who say that they fear nowt should not be prepared to take action.
I hope that the House will give its blessing to the new clause. I know that there are some Conservative Members who will at least have some sympathy with the notion. I hope that the Government will for once feel it in their bones tonight to say yes to the advice that has been given not only by the official Opposition but by the Government's own advisers.

Mrs. Currie: I listened to the hon. Member for Liverpool, West Derby (Mr. Wareing) with interest. It is clear from this and the previous debate that some hon. Members feel that they know much more about medicine than doctors do. That will sound a little odd when one considers what they will be saying on clause 13 tomorrow.
Our objective in much of what we are trying to do is to obtain better health and better value for money. Those are the objectives set out in the White Paper. I am sure that the objectives of the hon. Member for West Derby are the same. Therefore, it is a pity that he felt obliged to have a go at the drug companies in the way that he did.
When we discussed some of these issues in Committee it was clear that some hon. Members—I am not sure about the hon. Member for West Derby—would solve the problems that he described by nationalising the pharmaceutical industry. Indeed, the hon. Member for Wakefield (Mr. Hinchliffe) admitted that.

Mr. Wareing: Why not?

Mrs. Currie: No doubt there are Labour Members who believe that they could run the pharmaceutical industry as well as they ran steel and shipbuilding and every other industry that was taken into public ownership but destroyed. The noble Lord Wilson put such rather silly thinking into context during a discussion about


nationalising high street shops that sold clothes. He said that he would have difficulty explaining to his constituents how nationalising Marks and Spencer would make it as efficient as the Co-op. Labour Members who think that they could run the pharmaceutical industry more efficiently should give that example some thought.

Mr. Wareing: I know that you, Mr. Speaker, will bring us to order if we stray too far from the new clause, but will the Minister ask her right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath) about the nationalisation of Rolls-Royce in 1972? Was that a waste of taxpayers' money?

Mrs. Currie: I am delighted that the hon. Gentleman takes such an interest in my constituents. We have handed Rolls-Royce back to the private sector and everybody in Derby is thrilled to bits.
Given the philosophies of Labour Members, it is not surprising that a small number of companies have reacted in political terms in the way that the hon. Gentleman described earlier.
My Department is the sponsoring Department for the pharmaceutical industry. We should be proud of the industry's achievements, which depend on a strong base and on achieving a reasonable rate of return for its investment, particularly in research and development. If we were to force generic drugs on the National Health Service in the way suggested, the effect on the industry would be substantial and adverse. We are talking about 87,000 people directly employed in the United Kingdom in 1988 by Association of the British Pharmaceutical Industry companies. They estimate that indirect employment amounts to 250,000 jobs. Their capital investment in the United Kingdom will be about £400 million this year and their exports amount to £1·7 billion. The net positive United Kingdom trade balance in pharmaceuticals is about £850 million per year.
The pharmaceutical sector, which the new clause would so damage if it were passed, is the most significant contributor to the United Kingdom's balance of trade, after oil and transport. Most significant of all is its research and development spending. The industry estimates that this year it will spend £700 million in the United Kingdom on research and development. Indeed, about 10 per cent. of all British and manufacturing industry research and development spending is contributed by the pharmaceutical sector.
The case is always put to us—we take it very seriously—that research and development are strongly linked to our spend with the industry. If the National Health Service had to carry out the necessary research and development, I am sure that the cost would be greater than the amounts that I have just mentioned.

Mr. Wareing: Does the Minister agree that the new clause would not interfere with the patent rights of pharmaceutical firms? Those patent rights, covering a period of 20 years, give full compensation for research and development costs.

Mrs. Currie: The hon. Gentleman is quite right. The new clause does not interefere with existing legislation. He will be aware that there are active and heated discussions going on elsewhere about the length of time for which a

patent should apply. The drug companies have strongly expressed the view to us that they would be most concerned if generic prescribing were to be made compulsory. We should be aware of the vast amount of research and development that the industry does, using the money that we pay it—we are the largest purchaser of its drugs—and which we would have to do if we were to match the amount that it is doing at present.
The Guardian of 15 March 1988 reported that Glaxo had increased its research and development costs from £67 million to £101 million, which was reported recently to the company shareholders. It is expecting to spend £220 million in the full year, and that is an enormous amount of money. I understand that Glaxo is to spend £500 million over the next five years building a brand new medical research centre at Stevenage, employing up to 2,000 people. That includes some 600 new jobs. I wish that it were in Derby. It will develop new treatment for infectious diseases, cancer and immunology. It will rank among the most advanced research facilities in the world.
Companies can do that only if they know that their products will be prescribed in the way that they are now. I was interested to hear that the hon. Member for West Derby is in favour of a selected list. I listened to his eulogies with great interest. I was a Back Bencher at that time and I remember that Opposition Members spoke against the limited list. I also remember that Opposition Members predicted all sorts of dire consequences as a result of what my hon. Friends were going to do at the time. I also seem to remember that Opposition Members voted against it. St. Paul's conversion on the road to Damascus offers a reasonable analogy to what the hon. Gentleman has just said. We will bear his views in mind.
The new clause seeks the complete and compulsory use of generic products. We do not agree. The Opposition have argued that it would save money. Once again, I applaud the Opposition's interest in that objective. This evening for the first time, with the possible exception of the merit awards, they are keen that we should get value for money in the Health Service.
We believe that we can save money without compulsion and that a better overall objective would be better prescribing. That goes wider than generic substitution. As the hon. Gentleman rightly said, there have been sharp improvements in generic prescription, without any compulsion. He mentioned that the number of prescriptions being written and dispensed generically in Great Britain had doubled from 14 to 28 per cent. in the 10 years between 1976 and 1986.
Even more interesting is the fact that the number of prescriptions written generically but not necessarily dispensed generically, as there may not be a suitable generic product and the doctor writes the generic name, has gone up from 20 to 38 per cent. That means, broadly speaking, that some 40 per cent. of prescriptions are being written in a way that would meet with the hon. Gentleman's approval. The percentage is much higher in England than in Wales or Scotland, and perhaps hon. Members might take that on board.

Mr. Tam Dalyell: I am a friend of many of the drug companies, yet they deplore what they are doing in relation to pure research. The Minister should consider the concern of the drug companies, which is shared by Sir George Porter and others, that the Government do not put nearly enough into fundamental science. The Minister


mentioned Scotland. The understandable and justified squeals from the department of biochemistry—a very distinguished department at Edinburgh—are one example of the shortage of funds for basic sciences. The Minister and her Department should do something to persuade the Government to spend more on pure scientific research at the universities.

Mrs. Currie: The Government will respond in the usual way to the report of the Select Committee in the other place. We will take into account everything that is said.
I recall that one of the criticisms that is often put to British researchers is that we are very good at basic sciences but pretty hopeless at getting those excellent discoveries brought into development and use. That is not an adequate criticism of the pharmaceutical industry. This industry does basic science and funds a lot of research, including that in university departments. It puts a heck of a lot of money into first-class research and development and brings to the market marvellous drugs to which many of us owe our lives and for which many of us are very grateful. I take seriously what the hon. Member for Linlithgow (Mr. Dalyell) said; I merely suggest that some aspects of the pharmaceutical industry are a first-class example to other industries for which I do not have direct ministerial responsibility.
I agree with many of the points made by the hon. Member for West Derby about local initiatives to improve prescribing. Voluntary measures to improve prescribing are achieving considerable savings. For example, in a group general practice in Scotland, the introduction of a formulary saved about 10 per cent. in terms of cost per person and per item. In Hampshire, the local medical and pharmaceutical committees have estimated that it might be possible to achieve a potential saving of up to £3·5 million. They propose to achieve that saving in a number of ways, including standardisation to 28 days' supply, a two-week trial for new medicines instead of a month, and the greater use of five-day courses for antibiotics, rather than seven.

On that basis—

It being Ten o'clock, the debate stood adjourned.

Ordered,
That, at this day's sitting, the Health and Medicines Bill may be proceeded with, though opposed, until any hour.— [Mr. Peter Lloyd.]

Question again proposed, That the clause be read a Second time.

Mrs. Currie: On that basis, there is considerable scope for other local family practitioner committees and local medical committees to copy. In hospitals, the introduction of a formulary and management system has resulted in substantial savings. Guy's hospital, for example, experienced a decrease in actual spending of 16 per cent. over a four-year period, which is a constant price saving of 29 per cent. From a meeting that I had this morning with the chairmen of a number of family practitioner committees I know that a number of them are interested in using the Guy's hospital formulary.
Wandsworth has had a decrease in actual expenditure of 12 per cent. over four years as against a 20 per cent. increase in activity. Ninewells, which is the teaching hospital in Dundee, effected a 15 per cent. reduction in drug costs on the medical wards in the first year of introducing a formulary. Westminster hospital has

demonstrated a sustained reduction over seven years and spent 23 per cent. less, in constant price terms, at the end than it spent at the beginning.
We take on board, therefore, much of what the hon. Gentleman has said. In other parts of the country, similar initiatives are being taken. There is a great deal of local interest in more economic prescribing. That is the basis on which to proceed, rather than by compulsion and limiting ourselves to generic prescribing.
The overall drugs bill for the National Health Service is now over £2 billion, of which £1·6 billion is spent by the family practitioner service. We probably have more influence over the price of the drugs that we buy than many purchasers in other countries. Our negotiations with this important industry are designed to strike a balance between maintaining the strong, vigorous, research-based industry which we have in the United Kingdom and which it is in all our patients' interests to have, and obtaining value for money for patients. Our voluntary system does both. Compulsory generic substitution would probably do neither. Therefore, we reject the new clause.

Mr. Jack Ashley: It is all very well for the Minister to say that she is proud of the pharmaceutical industry. The pharmaceutical industry has far too many blotches and blemishes for that kind of uncritical and complacent attitude.
I do not propose to go on about Opren. If I did, you, Mr. Speaker, would say that I was out of order, because Opren is not a generic product. The Minister, with her pathetic and inadequate advice on that subject, ought to know that she cannot say that the pharmaceutical industry is something to be proud of. It is not. The pharmaceutical industry has produced some fine products, it has a fine record and it deserves great praise, but the Minister ought to reconsider her views and look far more carefully and seriously at the pharmaceutical industry's shortcomings.
I support new clause 5. When drugs are supplied, they should be generic products. I want to speak about tranquillisers. If generic products are supplied, the effects will be much the same as the effects of those dreadful products that are not generic, such as Opren and, in particular, Ativan which are tranquillisers and have caused such terrible damage to millions of people.
The campaign by The Observer in articles by Carmel Fitzsimons has done a great deal to alert the public to the grave and tragic effect of tranquillisers. It is a horrifying story which should disturb the House.
On 25 March, in a fairly remarkable answer to a parliamentary question, the Minister for Health said that half a million people were dependent on benzodiazepines in 1986, compared with 28 in 1977. What is the reason for that astounding increase? It is staggering, and demands immediate investigation.
In June 1984, the Minister said that the Department was fully aware of the public and professional concern that some people might be dependent on prescribed minor tranquillisers. Although the Department was "fully aware", very little has been done by the Government to deal with this grave medical problem. It is appalling that, in the four years since that answer, there are still 25 million prescriptions of tranquillisers every year, and half a million people are affected. Many are generic products. Some are not sold.
I find it shocking that research was not conducted originally into whether those tranquillisers caused


dependency, and that general practitioners prescribed them so casually, despite warnings from the Committee on Safety of Medicines. The doctors have nothing to be proud of.
I also find it shocking that the British drug industry is not working actively to help and advise those who are addicted on how to reduce their dependency, and that the drug industry of which the Minister says that she is so proud, ignoring all its shortcomings, is not actively seeking research and treatment for addicts. It is also very serious that the Department is not leading, rather than following, the voluntary organisations in tackling this serious drug menace.
The pharmaceutical industry of which the Minister is so proud has a major responsibility to help. It should embark on a major research project to help to overcome the problems of addiction. The industry of which the Minister is so proud is mainly responsible for the problem of addiction. It caused the problem, and it should do something to solve it instead of sitting back and enjoying the profits. It should work with the Government in a co-operative endeavour to help.
I hope that the Minister will listen to these reasoned, moderate criticisms, and will get together with the pharmaceutical industry and say, "Let us try to do something to help the millions of people who are suffering."
Clear warnings should also be visible on all prescriptions, as is done in the United States. Why cannot these innocent people, who are seeking help because their nerves are bad and the stress is so great, see a warning on the bottle? That would be simple, easy and reasonable, and I think that it should be done. It is wrong that people should have to rely on doctors' advice, because far too often doctors do not bother with advice from the Committee on Safety of Medicines. They are too busy, indolent, or sometimes ignorant. There are some fine doctors, but there are some bad doctors. We cannot rely on the bad doctors. Certain notices should be on the bottle.
The Minister should launch a vigorous campaign to prevent the further spread of addiction to tranquillisers, in particular benzodiazepines, and ensure that back-up support is available.
I know that the Minister's Department is short of cash, but I hope that she will do what she can to finance the marvellous work of voluntary organisations such as Tranx-line, and the one in London whose name I have forgotten.

Mrs. Currie: We already do.

Mr. Ashley: Perhaps the Minister will help them a little more because they are short of money.
If the Minister takes my proposals on board, she will help millions of people. I spoke last week to a man who talked of committing suicide because of his addiction to tranquillisers. He has tried to end his addiction, but he has hallucinations and he is driven round the bend. He needs help, support, advice and comfort.

Mr. Wareing: I am obliged to my right hon. Friend for raising that issue. In many respects, he contradicts what the Minister said. I noticed that the Minister was nodding her head vigorously and saying that the Government are

funding those voluntary organisations. However, the Government have only pump-primed them, with no more than £333,000. For example, the Council for Involuntary Tranquilliser Addiction in Merseyside has received no money at all. Much more is being spent on combating the abuse of hard drugs. Very little is going to the voluntary organisations which are so useful to the NHS.

Mr. Ashley: I appreciate that point. The Minister has written me a letter explaining what she does for the voluntary organisations. However, the voluntary organisations in Liverpool have said that they receive very little indeed. In fact, they have said that they receive nothing. Therefore, the Minister must face the challenge of whether to help such organisations. The organisations are complaining of poverty and a lack of Government help in their work in assisting addicts.
I do not want merely to score points; I want the Minister's help and co-operation. If we all work together we can reduce the suffering of the millions of addicts. Let us help them to beat their addiction. Let us help to prevent addiction. That can be done only if the Minister stops saying that she is proud of the pharmaceutical industry, looks at the blemishes and takes on board the criticisms. The pharmaceutical industry has a fine record, but it also has many blemishes and it is the blemishes that should be examined. The Minister should do something to help those addicts.

Mr. Geoffrey Dickens: My hon. Friend the Minister is right to praise the pharmaceutical industry. I shall explain why. In 1840, or thereabouts, the average life expectancy was 27 years. Now people can expect to live deep into their 70s and beyond. In fact, Her Majesty the Queen sends out more telegrams of congratulation to people who have reached 100 years of age than ever before.
That is a great tribute to the medics of this country and to the pharmaceutical industry. It is a great credit to all of them, but people must remember that, when pharmaceutical companies put money into research and development for new drugs to sustain life and make people more comfortable, they also put thousands of pounds into unsuccessful research. When they develop a drug that is useful to mankind, they do a tremendous service. They then have to develop a plant, so they have to make capital expenditure on a processing plant to produce and market that research product.
The companies also have to think in terms of recovery in two or three years' time to recover that money. It is right, therefore, that they should have the right sort of profit margin for research and development and to recover the capital costs of their plant. They talk in terms of two or three years because, by that time, someone often develops a new drug and puts it on the market. Therefore, the great profit that people say pharmaceutical companies enjoy goes to another company. However, at the same time, it is healthy competition. It is developing drugs for the good of mankind. It is totally unfair to criticise the Minister for saying that we owe—

Mr. Jeremy Corbyn: Will the hon. Gentleman give way?

Mr. Dickens: No, I shall not.
It is unfair to criticise the Minister for saying that we owe a great debt to the pharmaceutical industry. I venture to suggest that there is scarcely an hon. Member in the Chamber this evening who has not been thankful to the pharmaceutical industry. We have wonderful medics in this country, some of the best in the world. We have wonderful pharmaceutical industries, some of the best in the world. It is right that they should be developing and researching new drugs to sustain mankind up to and beyond the age of 70, instead of the age of 27, as it was in 1840. That speaks for itself.

Dr. Moonie: I had not intended to intervene so quickly in the debate, but I could not resist the temptation, having listened to the absolute drivel that has been promulgated for the last five minutes.

Mr. Greg Knight: The hon. Gentleman is the expert on drivel.

Dr. Moonie: Yes, I am, particularly when it comes from the Conservative Benches on my own subject, which is the role of medicine in the health of the community and particularly the role of the medical profession. I cannot understand how anyone with a basic education could imagine that a major percentage of the increase in life expectancy of the human race is due to the medical profession. Even the medical profession would not have claimed that. I have never heard such rubbish in all my life.
The hon. Member for Littleborough and Saddleworth (Mr. Dickens) disgressed a little from the subject. The increase in life expectancy is due not to the benefits of drugs, but to the way in which life expectancy from birth is calculated. Almost 90 per cent. of the improvement is due to the change in infant and perinatal mortality, which means that the nine out of 10 babies that used to die early in life no longer do so. That is why life expectancy has increased. In the 1840s, if one was fortunate enough to survive beyond the first or second year, one's life expectancy was little shorter than it is now.
The other factors that have played a part are the development of decent wages and conditions, good housing and an adequate diet. Those factors, not the medical profession, have led to an increase in life expectancy.
Let us consider the wonderful pharmaceutical industry. Unlike most hon. Members present tonight, I have worked in the industry and in the development of new drugs—the wonderful new products about which everyone talks. I can think of possibly three over the past 10 years that could be dignified with the description of a major advance in treatment.
Some 95 per cent. of those drugs are what we call "Me, too." someone develops a new product and someone else comes along, takes the formula, makes minor changes, gets a patent and puts it into animals and man. Lo and behold, the new drug has the same effect as the drug that came before it. Small wonder, because it is effectively the same drug. It is not claimed that the new drug is better. However, largely spurious statistical studies are carried out which conclude that the drugs are equally effective. In fact, the conclusion shows that both drugs have the same effects and the effects are indistinguishable. That means that both drugs might be ineffective, and frequently they are.
The drugs used in the vast majority of cases are not terribly effective. They may help us to bear some of the

chronic conditions that we suffer nowadays, but they do not cure them. They do not cure any of the modern illnesses like diabetes or arthritis, from which so many people suffer. They cannot cure heart disease, hypertension, arteriosclerosis, or senile dementia.

Mr. Dickens: I realise that the hon. Gentleman is a self-confessed doctor, and I am surprised at his comments. With regard to diabetes, why is the doctor saying that drugs just make people comfortable when he knows jolly well as a medical man that, unless a patient's blood count is right, with the right dose of insulin or sugar, that patient can go into coma and possibly die? How can the hon. Gentleman stand up and give false information when he knows differently from his training?

Dr. Moonie: The trouble is that once one has experience of the subject, one learns that things are not always as they seem. Diabetics certainly do not die as young as they used to, but they are not cured. They receive help to manage their affliction. However, although advances are being made which may change this, at the moment they die in later life from different but related conditions and suffer a great deal in the process. This is a serious matter and we should be careful before we give unrestricted praise to the medical profession or the pharmaceutical industry.

Mr. Corbyn: My hon. Friend is making a valuable contribution, which is more than can be said for some of the other contributions this evening. My hon. Friend obviously has experience of the drugs industry from his work as a doctor. Does he have any comment to make on the wastefulness of competition and the wastefulness of very high profit margins enjoyed by the privately owned drug companies at the moment?

Dr. Moonie: The profit margins on successful drugs are extremely high, as I am sure this Government and their predecessors are only too well aware. Hence the restricted list, which was rightly brought in several years ago to restrict prescribing costs. It is legitimate in a society in which drugs are manufactured by private companies to ensure that those companies receive a return on their investment; otherwise we would not have their investment and we might have to look elsewhere for it.
We are perhaps over-generous in the amount of compensation that we give private companies. For example, over the past 20 years Hoffman La Roche has produced drugs that are of virtually no benefit to mankind. For many years it has charged the Health Service inordinate prices for those drugs, and it now leads the struggle against the provision of generic substitutes for those very products. It knows full well that the drugs can be made for pence, yet they can be sold by the company under brand name protection for pounds.
Generic drugs are sound, safe and subjected to the same, if not more, stringent testing for solubility and type of action—I will not go into that, as it is a highly technical point—and they are as effective, or ineffective, as the products with which they are competing. However, generic drugs have the singular advantage that they are much cheaper. Therefore, they can help our over-burdened Health Service to meet a greater proportion of its increased costs through saving money on its drug bills. For that reason alone, the new clause is worthy of support.

Mr. Wareing: I have listened intently to what the Minister has had to say. While I do not accept many of her


arguments, particularly about the worth of the pharmaceutical industry, I would not want to detract from the useful research done by the industry. My hon. Friends have pointed out that more quality control may be desirable, particularly with regard to benzodiazepines. I am not won over by the argument about trade, because we have had the experience of transfer pricing by Hoffman La Roche and other monopoly practices by pharmaceutical

companies. I am not at all happy that retail price maintenance, which was abolished over 20 years ago for most commodities, still applies to pharmaceutical products.
Having said that, however, I note that the hon. Lady has agreed to some extent with what Opposition Members have said. I am sure that we will return to this matter again and again, until generic substitution becomes the vogue in the National Health Service. Therefore, I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

New clause 7

HOSPITAL DOMESTIC SERVICES

`(1) Each district health authority and health board shall make such arrangements as seem to them reasonable for the provision of hospital domestic services.
(2) The Secretary of State shall have no power to direct district health authorities or health boards on whether they employ outside contractors in making arrangements under subsection (1).
(3) Notwithstanding subsection (2) the Secretary of State may specify minimum standards of hygiene to be required of arrangements under subsection(1).'.—[Mr. Norman Hogg.]

Brought up, and read the First time.

Mr. Norman Hogg: I beg to move, That the clause be read a Second time.
It is right that responsibility for domestic services in the National Health Service should lie with the district health authorities, or, in the case of Scotland, with the health boards. That may seem obvious, but there has been some activity on the part of the Government of late that leads us to believe that they take a different view. The DHAs and the health boards have responsibility for catering and cleaning. My colleagues and I believe it to be right that management should be as close as possible to the delivery of services.
The problems associated with domestic services have a great deal to do with poor pay and conditions, and little to do with poor management or lack of motivation. Recently the Government have sought means of privatising services through competitive tendering, and we have seen Whitehall telling the DHAs and health boards how it is to be tackled. There are more problems arising from under-investment in hospitals, low pay and buildings which are not conducive to efficient working than from the fact that the services are run by internal staff.
Circular letters have been sent by the Minister responsible for the Health Service in Scotland, the hon. Member for Stirling (Mr. Forsyth), and I am sorry that he is not here. Ah, he has just arrived. This is really something of an occasion, because we had hoped to have the services of the Scottish Health Minister in considering the Bill in Committee, but I can promise him that when we go into Committee next week on the School Boards (Scotland) Bill I will repeat all my speeches on the Health and Medicines Bill so that he will not have missed anything.
The Minister sent a letter to the health boards in Scotland telling them how they might proceed to privatise services, or, as he might prefer to say, to introduce competitive tendering. The result has been a fall in the morale of the staff of Scottish hospitals, culminating in days of action, and he must accept some responsibility for the present situation. One needs only to look at the experience of district health authorities in the privatisation of catering and cleaning to see that such a course is not in the best interests of patient care, which is the primary function of the Health Service.
The National Health Service provides a high standard of catering at extremely reasonable prices. I checked on that this afternoon and found that University College hospital, London, which has a staff of 72 in its catering service, provides 1,600 meals per day on a budget of just £1·28 per head per day. That shows how efficient the staff can be.
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I am sure that the Egon Ronay guide is widely read on the Government Benches, for reasons other than catering in the Health Service. It is certainly not widely read by the Refreshment Department of the House of Commons. The Egon Ronay guide commented favourably on National Health Service meals and concluded that the food at some of the private hospitals that were visited was little better than, and in one case was below, the average standard served by National Health Service hospitals in the same cities, despite the fact the private sector spends on average four times more per patient on food than does the state. The Egon Ronay guide was complimentary about the quality of the food and its presentation in the National Health Service. The same guide criticised private hospitals, describing their meals as "grossly over-priced". Therefore, when it comes to value for money, that is delivered by the staff in the National Health Service.
These days we hear a lot about cook-chill. I can remember the Minister telling us a lot about cook-chill in Committee. I believe that this system of providing food could prove misguided in terms of the needs in the National Health Service. Indeed, it could well prove disastrous. It can destroy up to 90 per cent. of the vitamins in the food, as well as reduce its palatability—

Mr. Newton: Rubbish.

Mr. Hogg: The Minister for Health says "Rubbish", but I am sure that if he has been asked to reply to the debate he will explain why. All the evidence that I have been able to gather on this subject suggests that that is not a good way for us to proceed in the National Health Service and that there are considerable dangers from wrongly treated food.
There is some evidence that many of the catering staff in the service give up because they find that they are no longer able to earn overtime because of the introduction of that system, which means that they are not able to sustain their standard of living. Indeed, the poverty level wages paid in the National Health Service are not adequate in the first place—

Mr. Newton: I am not sure whether I should intervene but I addressed a seminar of cook-chill on Sunday evening which was no doubt very good for my soul. The hon. Gentleman will doubtless further explain his concerns for the staff, but I advise him that the purpose of a hospital food system is to provide good quality palatable food for the patient, hot and at the right time. There is little doubt that cook-chill is capable of doing that better than most conventional systems.

Mr. Hogg: I do not know where the Minister delivered his lecture on cook-chill last Sunday evening. I did not realise that he was the Government's answer to the "Galloping Gourmet".
My point about the staff is that where they are employed for the job for which they are trained—that is the preparation, cooking, and serving of the food—they have to work overtime to sustain the service and their standard of living. The Government are using the process of cook-chill to achieve savings in the National Health Service, which results in those staff not being able to sustain their earnings and, therefore, leaving the service. There is some evidence that, to fill the gap, cleaning and domestic staff are being brought in by contractors to


prepare the food, and there are dangers in that. I make that point to the Minister, and I hope that he will consider it again.
Poor pay is a major contributory factor to the problems in the National Health Service and it will not be resolved by privatisation. Low wages lead to low morale which leads to low motivation and low standards. If that was better understood by the Government, perhaps we would begin to get somewhere.
Notwithstanding the pay award which is pending, and which I hope the Government will fund fully, auxiliaries in the NHS start at £4,565 a year. A fully trained staff nurse gets £65 a week less than a fireman, and £109 a week less than a policeman. [Interruption.] It has a great deal to do with the problem. About 70 per cent. of nurses are forced to moonlight. The purpose of the new clause is to protect the service from privatisation, but if privatisation is introduced the problems will be aggravated. I do not know why the Government cannot understand that.
The underpaid jobs have one redeeming feature. We raised this in Committee, but the point has still not been adequately answered. In the radio programme in which I took part with the hon. Member for Stirling he did not answer the point. If staff have to engage in competitive tendering for their own jobs, and if the tender is successful and they become private employees in the NHS instead of being NHS employees, is it not the case that they lose their superannuation rights? That point should be clarified, because the superannuation right is the only redeeming feature of the underpaid jobs. What happens to the superannuation rights of someone working for a private company who was previously a public service employee? This must be clarified, because superannuation is an important consideration for people with such poor employment conditions.
Privatisation threatens the whole of patient care, which is the primary function of the National Health Service. Privatisation moves out of the hospital responsibility for important functions, most notably hygiene. Conservative Members are enthusiastic about the introduction of private services, but they do not realise that work in a hospital is a team job and that everyone has a commitment to achieve the highest standards of hygiene as an aid to patient care.
We are discovering a catalogue of horror stories which must be attributed to the fact that privatisation has become such a factor in some places. In Bromley, 351 jobs are documented as having been lost through privatisation. In Greenwich, 150 jobs have been lost, the prices of meals for staff have increased, some kitchens have been closed and more housekeeping duties are being carried out by nursing staff.
In Wandsworth, which is famous—or infamous—for privatisation, there were 739 job losses, the majority of which were 402 domestics at St. George's hospital in Tooting. In Ealing 100 jobs were lost as a result of a catering contract being won by a private contractor. In south London 125 jobs were lost in one case alone, in which a private hospital contractor won a domestic contract for Westminster hospital. The Association of London Authorities advises—[Interruption.] The Minister does not care for elected authorities. She much prefers to tell them from Whitehall how to run their affairs.
We know that she subscribes to the view that Whitehall knows best. However, in the hospitals in which the Association of London Authorities made inquiries, there were dirty baths and showers, filthy sinks and draining boards, unclean sterile treatment rooms, patient day rooms left unclean, and low staff morale.
On top of that, private contractors have not known what is involved in the cleaning of hospitals. They have not been able to find equipment. They have carried out cleaning procedures when it was not suitable to the immediately important task of hospital patient care. Their untrained staff have cleaned wards and clinics while nurses and doctors have been changing wound dressings and treating patients. There was an example of that at Queen Mary's hospital in Roehampton.
That stems from the fact that the Government do not recognise that hospital staff work as a team for the promotion of patient care and that they must understand what is required of them in the promotion of patient care. That is simply not possible by having private companies do the job in such a temporary way and with such a turnover of staff. Privatisation has been to the detriment of patient care.
One aspect that worries me is the coercion of health boards by the Government. The Under-Secretary of State for Scotland will know what I am about to say. It was deplorable that the chairman of Grampian health board was sent for when he and his board hesitated to act on the Under-Secretary's edict that they were to introduce what he calls competitive tendering in hospitals. The chairman was sent for and given the Star Chamber treatment. On top of that, the Under-Secretary of State for Scotland and the Secretary of State for Scotland are recorded as saying that the role of health boards in Scotland is to be the Government's agent.
The onward roll of centralism and central Government is the hallmark of contemporary Conservatism. I do not know where it will end, but we in Scotland maintain that the Under-Secretary of State for Scotland has little authority for insisting on a devolved Government role in Scotland and that it is unacceptable that members of health boards should be addressed in such a way. We are weary of the fundamentalists of market forces, who seem to be determined to shove their doctrines down the throat of an unwilling people, as is the case in Scotland.
The Government have no place for patient care in their policies. The House should recognise that by supporting the new clause.

Mr. John Redwood: I oppose the new clause. It is always disappointing when the Opposition come forward with ideas which are backward-looking and which in many ways conflict with the principles for which the National Health Service should stand. The NHS should be a national service, and to be a national service it needs common standards, some central direction and mission and some common administration and management purpose. The Opposition propose the opposite and seem to wish for a degeneration into local anarchy with no sense of central direction or management control.

Ms. Harman: The hon. Gentleman talks about common standards. Does he not recognise that of something like 400 performance indicators—statistics that the Government are now collecting—only about four


relate to the quality of service and all the rest relate to throughput and cost-cutting? Are those the common standards to which the hon. Gentleman refers?

Mr. Redwood: I do not entirely agree with the hon. Lady's analysis that only four of the performance indicators relate to the quality of care. Many of them relate to staff usage in relation to patient numbers and many people would suggest that that is a proxy for some elements of the quality of care. The majority of indicators are based on such ratios and calculations.
I hope that the House will agree that one should seek value for money in any health system. The Government have introduced proposals that attempt to provide better value for money. The new clause would reverse that process by resisting moves to provide better value for money in hospital domestic services.
I hope that most hon. Members will agree, too, that money should be concentrated where it is most needed—on patient care and on the services that go most directly to the patient. The fears that the Opposition express are strange. If it is true that the hospitals themselves can do the job best, they are free to bid for the business and to carry on as before, demonstrating that they are the cheapest and best and having pride in a job well done. It is curious that when competitions have been organised, the in-house services have often had to change their pricing, management style and many of their practices to win the bids. It is also curious that where the services have been put out to tender there have been substantial savings in most cases. That seems to give the lie to the idea that all the in-house services are absolutely perfect.
We have then to consider the question of quality. It is argued that quality falls down if services are provided by a private contractor. One of the advantages of a private contract, however, is that one can enforce the contract or sack the contractor. There is no advantage in the in-house system. It is a matter of regret that salmonella outbreaks occurring as a result of conditions in hospitals have often started in kitchens where no private caterers are involved. Such outbreaks would be possible under either system, but it is nonsense to let people believe that they happen only where services have been privatised given that the evidence points in the other direction.
If the NHS had a powerful chief executive with the necessary powers to put into place an efficiency drive across a range of activities, it would be quite easy for him, in a relatively short time to deliver £1,000 million of savings which could go straight into patient care. We should all be striving to achieve that. The National Audit Office has identified £300 million to £500 million of savings that could come simply from better use of properties. Several hundred million pounds more could come from the contracting-out of hotel-type services, and that is before considering the broad use of staff, which would be likely to produce savings if a sensible chief executive had the necessary powers.
The new clause would be a retrograde step which would stand in the way of better value for money, better patient care and better national management of the service.

Mr. Galbraith: I should like to make two specific points to the hon. Member for Wokingham (Mr. Redwood). The first is on efficiency. When Conservative Members speak about efficiency, they use the word as a euphemism for cheapness. When they talk about services being better,

they mean services being cheaper. The hon. Gentleman had to add as an afterthought the question whether the service might be better. When we talk about efficiency we mean efficiency in the provision of care, getting patients operations when and where they want them and by whom in the surroundings that they want. We do not mean the sort of efficiency that the hon. Gentleman talks about—cheapness at the expense of already low-paid workers in order to fill the pockets of Members who have interests outside the House.

Mr. Dickens: The hon. Gentleman is lecturing us on efficiency. Does he recall that when the Conservatives came back to power in 1979, the Government asked the regional health authorities for their manning levels and that hardly any of them could give us the up-to-date levels or, indeed, any levels? The ones that did give figures were 18 months out of date. That was the efficiency that was achieved under the Labour Government. How can the Opposition lecture us on efficiency in the Health Service?

Mr. Galbraith: I shall resist the temptation to lecture the hon. Gentleman because, even if I spoke to him quietly, he would not understand what I was talking about.
When the hon. Member for Wokingham talked about efficiency, he said that we needed to know more about the Health Service and the various factors that operate in it. Nobody disagrees with that, but there is more to efficiency than Conservative Members seem to think. There is more to it than cutting costs and looking at the financial aspect. As Ministers are always telling us, the purpose of the National Health Service is to provide care for patients. That must be the motivating factor, and it is done by increasing efficiency in the provision of care. Financial efficiency is cheapness, but it comes second to efficiency in the provision of care, in patients being seen when they want, by whom they want arid in the surroundings that they want.
The hon. Member for Wokingham spoke about releasing money for patient care. I do not think that the hon. Gentleman appreciates the point made by my hon. Friend the Member for Cumbernauld and Kilsyth (Mr. Hogg), that everyone in the Health Service is involved in patient care. If we move anyone, care is affected. Conservative Members must agree, because when porters withdraw their labour they are told that it affects patient care. There is a contradiction in the points made by the hon. Gentleman. We have had enough hypocrisy from Conservative Members. Let us concentrate on efficiency in the delivery of patient care and stop using euphemisms about efficiency when what is meant is simply cheapness.
I should like to speak to the new clause, which is more than the hon. Member for Wokingham did. It should commend itself to Ministers because it is all about democracy, devolving power and giving it back to the people. It is about devolution and letting decisions be taken where it matters. The hon. Gentleman talked about central control. How can things be controlled centrally if they are privatised to umpteen companies over which we have absolutely no control? That is the problem. Health boards wish to retain central control and Ministers ought to be keen to accept that, especially in view of the reassurances that they gave us about clause 4. The


Minister will remember that in Committee we discussed that clause. Clause 4(1)(g) provides that the Secretary of State
may give directions—
(i) for the exercise of any of those powers by any body constituted under the National Health Service Act 1977 or the National Health Service (Scotland) Act 1978; and
(ii) with respect to the manner in which any such body is to exercise any such power".
We wish to remove that power from the Minister, but he says that there is no problem about the matter, because it is power not to direct health authorities to do anything but to prevent them from doing silly things. The Minister said that it was to prevent them from putting up adverts for undertakers and charging money for them. For that reason, I am sure that the Minister will accept the new clause because it goes along with the philosophy that he put forward in Committee.
The other reason for the new clause is to prevent what recently happened in Scotland with health boards. Here I come to the hon. Member for Stirling (Mr. Forsyth). Michael Forsyth Ltd.—[Interruption] Michael Forsyth Ltd. has nothing whatever to do with the hon. Member for Stirling. I want to make it clear that, when I mention Michael Forsyth Ltd., it has nothing to do with the hon. Member for Stirling.
Here we have the great proponent of democracy who said that he wants parents to have power in education and wants to set up school boards but who will not allow local health boards to do anything. He directs them in a jackboot fashion against their wishes. He calls up the chairmen of the health boards and instructs them to tear up agreements. The health boards had agreements with the trade unions which brought about significant savings for the NHS and the hon. Member for Stirling—not related to Michael Forsyth Ltd.—told them to tear up the agreements. Can you imagine, Mr. Deputy Speaker, what Conservative Members would say if the trade unions were to tear up agreements? I remember Conservative Members saying that it is about time that trade unions stuck to agreements. Well, there were agreements and the hon. Member for Stirling—not related to Michael Forsyth Ltd.—told them to tear them up.

Mr. Dickens: Boring.

Mr. Galbraith: Well, I am going to bore hon. Members a little longer. As I have said, Michael Forsyth Ltd. is not related to the hon. Member for Stirling.
As a result of those agreements—I shall quote the figures of the hon. Member for Stirling—Scotland saved £20 million. The savings from privatisation in England and Wales are £100 million. The equivalent savings in Scotland from agreements with the trade unions are double those from privatisation in England and Wales. Therefore, that is an argument in favour of retaining the arrangements between the health boards and the unions and against privatisation.
We want to give the power back to the health boards to ensure that decisions are taken locally, that all people benefit and that decisions are not made by Michael Forsyth Ltd., which is not related to the hon. Member for Stirling.

Mr. David Hinchliffe: My hon. Friend the Member for Cumbernauld and Kilsyth (Mr. Hogg) set out coherently the arguments in favour of this clause. I was particularly interested in the fact that he referred to the cook-chill system. I was gratified to hear that the Minister has become an expert on cook-chill. I invite him to stick around until we reach clause 4 because I intend to refer in some detail to the cook-chill system in Wakefield and I would very much welcome his comments on that. I have tried endlessly to get some response from the Government on it. I hope that he will stay around until 3 or 4 o'clock tomorrow morning, or whenever we reach clause 4.
My hon. Friends have set out the reasoning behind new clause 7. It is about the need to ensure proper standards of hygiene within the NHS and about the rights of working people to fair wages and decent working conditions. Competitive tendering, as the hon. Member for Wokingham (Mr. Redwood) has said, is advanced by the Government for two main reasons. First, on ideological grounds, bringing private companies into the NHS is a move towards breaking up the state, with which the Government are obsessed. Secondly, there is the issue of financial savings, which the hon. Member for Wokingham referred to as value for money. Those savings are supposedly made by privatising various services.
I am sure that the hon. Gentleman will have heard on many occasions, as I have, the figure of £105 million quoted by Government supporters, as being the cumulative saving that has accrued as a direct result of the competitive tendering process. The figures have been used endlessly by Ministers and Government Back Benchers as a justification for turning the screw even further on more and more public services, particularly within the NHS. One can drive a coach and horses through the figure of £105 million; it simply is not accurate. I shall give a few pointers to why it is open to the gravest doubt.
First, the supposed savings do not take account of the time spent by district and regional health authorities on preparing and monitoring tenders. I understand that more than a year ago the National Audit Office estimated that that cost was at least £15 million per annum. Secondly, different accounting methods have been used by district health authorities to assess the base-line cost and to measure the so-called savings of competitive tendering. Consequently, the figures are highly unreliable. Thirdly, redundancy costs have not been accounted for in the savings advanced by Conservative Members, which have supposedly been achieved through competitive tendering. In many areas where people have been made redundant because of competitive tendering those costs are high. Fourthly—this is crucial if one is to assess the real figure involved in this issue—there is the financial cost of forcing hospital workers to be dependent on unemployment and social benefit.
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The Prime Minister constantly says that no Government have spent more than the present one on social security benefit. Of course that is true, but it is because they have made so many people redundant. They have put hospital workers on the dole and shoved their jobs out to private contractors. Those people are now claiming state benefit. That should be taken into account when considering the savings made by competitive tendering. About 2,000 jobs have been lost in the Yorkshire health authority since 1985, primarily because


of the competitive tendering process. Many of those people are now in receipt of state benefit. That fact should be taken into account when talking about the tremendous savings made through competitive tendering.
The savings made through competitive tendering are a fraud; they are a complete con trick. I would argue that it has cost public money to introduce competitive tendering, regardless of the problems of filth, catering difficulties and the major failures of numerous contracts that my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) mentioned.
I know that on any issue the Government think only in terms of cash, but recently the Prime Minister started lecturing the Church of England and the bishops about morality. Is it morally right that the Budget gave more money per week to some people by way of tax concessions than many National Health Service workers in a year? Is it morally right that people earning less than £70 per week should have their wages driven down? In Committee I gave the example of a taxi driver in Wakefield who collects me who has to moonlight. He showed me his pay slip. He receives £81 per week working as a porter, and that includes a 25 per cent. bonus. He has to keep a family on that sum of money, and when his job is put out to competitive tender shortly, even if the in-house tender is successful, his wages will be driven down further.
Is it morally right that people working in the most basic conditions should have them made even worse? Is it morally right that Tory Members, who have interests in private contracts, should speak in debates on the Health Service and vote on issues when they stand to gain financially? That happens time and again because the Government Benches are riddled by people who stand to gain from this issue. [HoN. MEMBERS: "Name them."] It would take me all night to name them.
As a policy, competitive tendering has been a complete and dismal failure. It has been a failure for the district health authorities and health boards that have had to bring it in. It has been a failure for the patients, and, most of all, it has been a failure for the loyal and hard-working employees of the National Health Service. I urge all hon. Members with a conscience to give their full support to new clause 7.

Mr. Corbyn: At last we have an opportunity to debate the hypocrisy that we have heard so often from Ministers and from the Government about privatisation and the alleged efficiencies that emanate from it. They know that it is complete nonsense. In promoting privatisation they are really after a featherbedded system to produce enormous profits for private contractors for cleaning or catering in hospitals. They know perfectly well that the end result of privatisation is a starvation wage for those who work for those private cleaning companies, and enormous profits for the companies, and filthy hospitals.
If the Government bothered to examine the results of the privatisation of cleaning in hospitals, they would find that there are quite appalling and astounding statistics about the number of contract failures. They would discover the number of times that doctors have refused to work in hospitals that are not clean enough, and the number of times that nurses have stopped doing nursing work because the wards are so filthy that the first priority is to clean the wards, not to carry out the necessary treatment of the patients.
The new clause, in a very modest way, is trying to improve the situation. Subsection (1) states:
Each district health authority and health board shall make such arrangements
as it wishes for catering services, cleaning services or any other services within a hospital.

Mr. Gerald Howarth: Will the hon. Gentleman give way?

Mr. Corbyn: I shall complete my point and then give way. The hon. Gentleman may have something useful to say, although I have my doubts.

Mr. Howarth: I am grateful to the hon. Gentleman for giving way. He said that the new clause states that health authorities shall make such arrangements as they wish. That is not what the new clause says. It says:
as seem to them reasonable".
Will the hon. Gentleman give the House his definition of reasonable?

Mr. Corbyn: The hon. Gentleman raises an interesting point, as there is a great deal behind it. My idea of reasonable is reasonable wages for the staff, a high standard of cleanliness and a high standard of service. Above all, the motives behind the provision of that service should be a clean hospital and good quality food for the patients, not the motive of rip-off profits for the fly-by-night companies that seek to run away from the Health Service at the first opportunity.
The hon. Gentleman knows perfectly well that it is wrong to have a Health Service dominated by private enterprise values that are interested only in making money out of the Health Service. Rather, it should consist of people who are determined to ensure the best possible standards for those who use the Health Service, namely, the patients.
The House should be aware of some of the issues referred to by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). A large number of Conservative hon. Members who have substantial shareholdings in contract cleaning companies regularly put pressure on the Government with regard to the Health Service—as they did at the Carlton Club private lunch, and as they do in boardrooms throughout the country and at dinner tables in this building. They try to convince the Government—who are readily convinced about such matters—that the one thing we need is central direction of health authorities by the Government—who are supposed to be against centralisation—to force them to hand contracts to private cleaning and catering companies. It is a corruption of our political system that that is allowed to happen in this building.
The lid should be taken off the hypocrisy that accompanies this issue and the claims by Conservative Members that there are great savings to be made in the Health Service if we privatise everything. The savings are to be made in the form of profits for companies at the expense of the standards of treatment for patients, of clean hospitals and of good quality food. The profits are made because of dirty hospitals, poor quality food and a high level of unemployment among people who formerly cleaned hospitals and cooked food there. If the Government doubt my word, they should go to hospitals where private companies now do the cleaning, examine standards and talk to people who previously were able to take pride in their work but who are now doing the jobs of


three of four people for a pittance. It is a disgraceful way to treat people who have given long service to the NHS and who are dedicated to it.
In reality, Conservative Members have nothing but contempt for manual workers in the NHS, who have kept the hospitals clean for so long. My hon. Friend the Member for Cumbernauld and Kilsyth (Mr. Hogg) said that hospitals cannot be run without catering and cleaning staff. It is about time that hon. Members understood the community of interest in hospitals. Those who clean hospital floors, empty bed pans, wash soiled sheets and do all the unspeakable jobs that Conservative Members would not do in a thousand years, never mind for the wages that manual workers are paid, are every bit as dedicated to the NHS as are doctors, nurses and research chemists. I make no apology for saying that or for reminding the House that I am sponsored by the National Union of Public Employees, which does not pay me one penny piece for making this speech. It exists to represent the interests of low-paid manual workers. It recognises that privatisation is the enemy of decent working conditions, decent staff morale and a good Health Service.
I want the Health Service to be free at the point of use and available to all. I also want it to operate on the basis of not causing fear among its staff, not putting low-paid workers' jobs on sale once a year to the lowest bidder and not forcing low-paid health workers to offer their services for even lower wages to some fly-by-night company that will exploit them for a year, after which somebody else will exploit them.
Ministers should revert to the direct employment system and end fear of low-paid workers in the National Health Service. I hope that the House will return to this issue again and again, so that the scandal of the appalling standards and working conditions that private cleaning and catering companies provide, their attitude towards their staff and their contempt for the Health Service can be further exposed. Then we shall return to a decent system of centralised employment that guarantees proper working conditions and jobs.

Mrs. Currie: As the hon. Member for Islington, North (Mr. Corbyn) has just reminded us, this is the trade union clause—the NUPE and COHSE clause. It was supported eloquently by the hon. Members for Islington, North and for Wakefield (Mr. Hinchliffe), who is also sponsored by NUPE. They are proud of that, and quite rightly, too. The hon. Member for Cumbernauld and Kilsyth (Mr. Hogg), who moved the new clause, is sponsored by NALGO. It includes among its members many senior managers in the National Health Service and in local government who know that much of what he said is wrong. They are running the system, and they are right to be proud of their achievements.
As for the comments of the hon. Member for Peckham (Ms. Harman) on the performance indicators, I cannot resist the comment that what she said suggests that she has not looked at them, any more than she looked at the General Practice Finance Corporation's annual report. I suggest that she takes another look at them. They are all about getting cost-effective patient care.
New clause 7 deals with hospital domestic services, which I understand mean services that vary widely throughout the Health Service from basic cleaning to a

fully developed hotel service, from internal linen distribution to pest control. Rather than improving the present service, the new clause would stifle the competitive tendering initiative that is being shown by managers, many of them members of NALGO, over domestic support services.
I was a little surprised, therefore, to hear all that was said about cook-chill. That is not a domestic service and it has nothing to do with the new clause. It is catering. But perhaps the hon. Member for Cumbernauld and Kilsyth normally eats his dinner off the floor.

Mr. Norman Hogg: rose—

Mrs. Currie: I am delighted to give way to the hon. Gentleman.

Mr. Hogg: The Minister is drawing a very narrow definition of "domestic". Perhaps that is because she does not really know much about domestic services. She probably has people to do them for her.

Mrs. Currie: You bet. The hon. Gentleman put down the new clause, and, judging by his opening speech, he clearly did not read it.
However, if we are to talk briefly about cook-chill, let me say that, as 387 catering contracts in England were won in-house and only 11 were won by outside contractors, the odds are that all the cooking that the hon. Gentleman and his hon. Friends have described—both good and bad—has been done by NHS staff who won their contracts through open competition.
Incidentally, the hon. Gentleman asked what would happen to superannuation. Let me remind him that when NHS staff win a contract they stay as NHS employees, just as local government employees who do the same stay as local government employees. Nothing happens to the superannuation of those employees. They retain all their superannuation rights, and all their other rights as well. If the hon. Gentleman and his hon. Friends are really putting about that kind of rubbish in Scotland, it is no wonder that his constituents—

Mr. Hogg: rose—

Mrs. Currie: I shall give way in a moment. I listened to the hon. Gentleman with all the dignity and courtesy that I could muster, and I have not finished my sentence yet.
If the hon. Gentleman and his hon. Friends have really been putting about that kind of rubbish in Scotland, it is no wonder that his constituents are upset, but it is not true. Nothing will happen to that superannuation, and if he even hints at it he is going much too far.

Mr. Hogg: One of the Minister's roles in the House is to answer reasonably questions that are put reasonably to her about Government policies as they apply to constituents of hon. Members on both sides of the House. The question was put to her because the position was not clear. No one has been putting about any rubbish in Scotland, and I am sorry that she has addressed me in that tone. She would do better simply to give us the facts. If she stuck to that, perhaps she would manage to win some support for herself in the country.

Mrs. Currie: I always listen to advice, even from Opposition Members. However, if the hon. Gentleman had even tried to consult members of NALGO, his own


union, they would have given him the facts as I have given them. Indeed, if he had listened to the speeches of my right hon. and hon. Friends in Scotland, he would have heard the same many times.
I listened to what was said by the Association of London Authorities. I felt that I would much rather the authorities used their rates in London to look after local ratepayers—for example, by improving services in the community which might assist patients being discharged from hospital—and not go poking around looking for very thin material to make political points that do no service whatever to the House.
The hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) waxed eloquent about democracy. He impressed me during the Committee stage of the Bill because it was clear that he was one of the few Opposition Members who had read the Bill and the White Paper, and he kept surprising himself by saying that he agreed with most of it. We appreciate that very much. Perhaps, however, the hon. Gentleman has not quite understood the new clause. I know that his name was not on it, so perhaps he was not consulted in the way that Opposition Members like.
The effect of subsection (1) would be to undermine the powers established under section 17 of the National Health Service Act 1977 and the National Health Service (Scotland) Act 1978 whereby the Secretaries of State can ensure the cost-effective delivery of the whole range of hospital services. Instead, health authorities and health boards would be permitted to act independently of central initiatives for domestic services, and would be able to choose to ignore the Secretaries of State. That is not acceptable, and is not in the interests of either patients or taxpayers.
The powers that the new clause seeks to annul were provided by a Labour Government. They are wise and essential, and we want to retain them. On that basis, I feel that the hon. Gentleman has got himself in a bit of a twist. The approach of the sponsors of the new clause is very disappointing, particularly because other Opposition Members are trying to be much more helpful.
I do not know whether hon. Members on either side of the House were able to hear the Leader of the Opposition taking part in a discussion over the weekend, which I thought very interesting and helpful. He said that not all public service was good and that not all private service was bad. That is entirely sensible and right and I commend that kind of approach—and perhaps some of that style—to the
hon. Gentleman.
Competitive tendering arouses strong feelings. That is a pity because, in the end, it is a method of achieving better service and better value for money. Competitive tendering is of proven value. More than £100 million has been saved and ploughed back into other patient services. There is also much greater emphasis now on setting and achieving standards in all these hotel services, and on tighter budgetary discipline and more flexible forms of provision. Eighty per cent. of the domestic service tenders to which this clause refers have been won in-house and, on average, costs have fallen by 23 per cent. That is a tribute to the managers concerned, most of whom are members of NALGO, and perhaps most of all to their staff, most of whom are members of NUPE and COHSE.

Mr. Galbraith: The Minister has used the same figure mentioned in my speech—that £100 million had been

saved in England and Wales through privatisation. Does she agree that the savings made in Scotland from the agreement trade unions have with the health boards without privatisation is £20 million, which is equivalent to double the savings in England and Wales?

Mrs. Currie: I heard what was said by the hon. Gentleman the first time because, whatever my public reputation might be, I do listen and I have an answer ready for him. He spoke of a figure of £20 million saved in Scotland. That is the accumulated figure over a number of years in Scotland.

Mr. Galbraith: Over how many years?

Mrs. Currie: The figure of more than £100 million is the English annual saving, and so the two are not exactly comparable. Even so, I cannot see what the hon. Gentleman is so upset about. The money goes straight back into the National Health Service for patient care. That involves employing people, too, and it involves looking after patients.
Indeed, when it comes to the matter of employment and the point made by the hon. Member for Wakefield the National Health Service has more than done its bit in recent years. It now employs some 1¼ million people, which is not only a national record but makes it the biggest employer in western Europe. The NHS now employs far more people than it did in the days when Labour last lost its grip on power, which I believe was way back in 1979.
We are now starting the second round of tendering in England. Progress is being made in Wales, and the first round is under way in Scotland. All the health boards in Scotland are now engaged in the preparatory work that is necessary before seeking tenders. Indeed, I understand that some tenders have already been let. We expect that the exercise will be as fruitful in Scotland as elsewhere, and to the benefit of patients.
The total amount involved in respect of domestic services in Scotland is more than £50 million, and if the savings are even close to those we have experienced elsewhere many millions of pounds are likely to be involved.
The same fears that have been expressed today were expressed in England some time ago when our competitive tendering exercise began. They proved to be unfounded. We believe they will prove to be unfounded in Scotland as well. We deplore the methods by which some views have been expressed outside.
Due to industrial action in Scotland, some 3,500 operations have been cancelled; 3,500 Scots people are suffering unnecessarily. Knowing hon. Members as I do, I doubt very much whether some of them—at least the hon. Members for Strathkelvin and Bearsden and for Cumbernauld and Kilsyth—are proud of the fact that 3,500 Scots people have been suffering unnecessarily. They did not intend that it should happen, but it has. During the recent industrial inaction, 90,000 meals were disrupted in Scottish hospitals. I am sure the food there is very good—certainly it was when I was in Scotland recently—but it helps patients if the food is actually served and if meal times are not disrupted.
We strongly agree about the importance of public health and hygiene and we have taken strong action in the past 18 months to safeguard hygiene standards throughout Britain through sections 1 and 2 of the National Health Service (Amendment) Act 1986. It gave


me great pleasure, as one of my first tasks at the Dispatch Box, to be involved in the passage of that legislation. The result has been a greater awareness of locally determined control of infection policies and improved understanding and collaboration between health staff, environmental health officers and health and safety inspectors, many of whom are members of NALGO.
All health authorities have responsibility for maintaining standards, whoever does the work. We have no plans to change that system. I note the comment of Opposition Members about private companies, but, as my hon. Friend the Member for Wokingham (Mr. Redwood) hinted, all the successful prosecutions since the removal of Crown immunity have concerned in-house, not private, contracts. We want the highest standards whoever does the work and we hold the health authorities responsible.
The hon. Member for Wakefield commented on catering standards in his constituency. Let me gently remind him that it was the appalling events in the kitchens of one of the hospitals there which were perpetrated by NHS staff and which resulted in a number of deaths of patients which resulted in the changes in the law that I have just described. The health authority in Wakefield was responsible then for the standards achieved—if that is what one could call them—and it is responsible now for the standards that are achieved, and we shall continue to hold it responsible.

Mr. Hinchliffe: The Minister should look again at the inquiry report on the Stanley Royd hospital, because she does not seem to have grasped exactly what it said. It referred to the conditions in the kitchen, which had nothing to do with the staff. The appalling fact was that they were working in an old workhouse building because of lack of investment in the NHS. The Minister might also care to comment on the fact that the new £1 million kitchen has been ready for a year but has not been used because of cuts in the NHS.

Mrs. Currie: I have just made my comments about the previous incident and about current catering in Wakefield. The health authority is responsible and will continue to be so.
The new clause seeks to destroy the initiative being shown by Ministers, health authorities and boards in our aim, which I think that some Opposition Members would share, to combine high quality service with value for money. Dare I suggest that some of the dislike of competitive tendering of NUPE and one or two other unions stems from a dislike of open competition, a fear of public scrutiny and a concern about the subsequent disappearance of the so-called Spanish practices which have plagued the NHS for far too long. The fact that the system in England is working should not upset them so, but it upsets NUPE and COHSE because they have most to lose.
We are pleased to see the success of competitive tendering and we do not intend to let that be damaged or destroyed in the way proposed. If Opposition Members decide to press the new clause to a vote, we shall vote it down.

Mr. Norman Hogg: Opposition Members have listened carefully to the Minister. I regret that we are far from persuaded that she is anything other than just a believer in

what she says, but cannot really substantiate it with fact. Her figure of £100 million, which we have heard endlessly, has been challenged time and again, whereas the figure of £20 million, which has been produced for Scotland. has not been satisfactorily dealt with. That figure was founded on trade union agreements, not on privatisation.
However, the Opposition have come to understand that we are never able to persuade the Government of anything because they have closed minds. They do not believe in the NHS, they voted against its formation in the late 1940s, and they are destroying it now. We shall not let them do it and we shall press our new clause to a vote.

Question put, That the clause be read a Second time:—

The House divided: Ayes 202, Noes 307.

Division No. 256]
[11.30 pm


AYES


Abbott, Ms Diane
Douglas, Dick


Adams, Allen (Paisley N)
Duffy, A. E. P.


Allen, Graham
Dunnachie, Jimmy


Alton, David
Dunwoody, Hon Mrs Gwyneth


Archer, Rt Hon Peter
Eadie, Alexander


Ashdown, Paddy
Ewing, Mrs Margaret (Moray)


Ashley, Rt Hon Jack
Fatchett, Derek


Ashton, Joe
Fearn, Ronald


Banks, Tony (Newham NW)
Field, Frank (Birkenhead)


Barnes, Harry (Derbyshire NE)
Fields, Terry (L'pool B G'n)


Barron, Kevin
Flynn, Paul


Beckett, Margaret
Foot, Rt Hon Michael


Beggs, Roy
Foster, Derek


Beith, A. J.
Fraser, John


Bell, Stuart
Fyfe, Maria


Benn, Rt Hon Tony
Galbraith, Sam


Bermingham, Gerald
Galloway, George


Bidwell, Sydney
Garrett, John (Norwich South)


Blair, Tony
George, Bruce


Boateng, Paul
Gilbert, Rt Hon Dr John


Boyes, Roland
Godman, Dr Norman A.


Bradley, Keith
Graham, Thomas


Bray, Dr Jeremy
Grant, Bernie (Tottenham)


Brown, Gordon (D'mline E)
Griffiths, Nigel (Edinburgh S)


Brown, Nicholas (Newcastle E)
Griffiths, Win (Bridgend)


Brown, Ron (Edinburgh Leith)
Grocott, Bruce


Bruce, Malcolm (Gordon)
Hardy, Peter


Buchan, Norman
Harman, Ms Harriet


Buckley, George J.
Hattersley, Rt Hon Roy


Caborn, Richard
Haynes, Frank


Callaghan, Jim
Heffer, Eric S.


Campbell, Menzies (Fife NE)
Henderson, Doug


Campbell, Ron (Blyth Valley)
Hinchliffe, David


Campbell-Savours, D. N.
Hogg, N. (C'nauld &amp; Kilsyth)


Canavan, Dennis
Home Robertson, John


Carlile, Alex (Mont'g)
Hood, Jimmy


Clark, Dr David (S Shields)
Howarth, George (Knowsley N)


Clarke, Tom (Monklands W)
Hoyle, Doug


Clay, Bob
Hughes, John (Coventry NE)


Clelland, David
Hughes, Robert (Aberdeen N)


Clwyd, Mrs Ann
Hughes, Simon (Southwark)


Cohen, Harry
Illsley, Eric


Cook, Frank (Stockton N)
Janner, Greville


Cook, Robin (Livingston)
Jones, Barry (Alyn &amp; Deeside)


Corbyn, Jeremy
Jones, leuan (Ynys MÔn)


Cousins, Jim
Jones, Martyn (Clwyd S W)


Cox, Tom
Kaufman, Rt Hon Gerald


Crowther, Stan
Kilfedder, James


Cummings, John
Kirkwood, Archy


Cunliffe, Lawrence
Lambie, David


Cunningham, Dr John
Leadbitter, Ted


Dalyell, Tam
Leighton, Ron


Darling, Alistair
Lewis, Terry


Davies, Rt Hon Denzil (Llanelli)
Litherland, Robert


Davies, Ron (Caerphilly)
Lloyd, Tony (Stretford)


Davis, Terry (B'ham Hodge H'l)
Lofthouse, Geoffrey


Dewar, Donald
Loyden, Eddie


Dixon, Don
McAllion, John


Dobson, Frank
McAvoy, Thomas


Doran, Frank
McCartney, Ian






Macdonald, Calum A.
Richardson, Jo


McFall, John
Robertson, George


McKay, Allen (Barnsley West)
Robinson, Geoffrey


McKelvey, William
Rogers, Allan


McLeish, Henry
Rooker, Jeff


McTaggart, Bob
Ross, Ernie (Dundee W)


McWilliam, John
Ross, William (Londonderry E)


Madden, Max
Rowlands, Ted


Mahon, Mrs Alice
Ruddock, Joan


Marek, Dr John
Salmond, Alex


Marshall, David (Shettleston)
Sedgemore, Brian


Marshall, Jim (Leicester S)
Sheerman, Barry


Martin, Michael J. (Springburn)
Sheldon, Rt Hon Robert


Martlew, Eric
Short, Clare


Meacher, Michael
Skinner, Dennis


Michael, Alun
Smith, C. (leton &amp; F'bury)


Michie, Bill (Sheffield Heeley)
Smith, Rt Hon J. (Monk'ds E)


Michie, Mrs Ray (Arg'l &amp; Bute)
Snape, Peter


Milian, Rt Hon Bruce
Soley, Clive


Mitchell, Austin (G't Grimsby)
Spearing, Nigel


Molyneaux, Rt Hon James
Steel, Rt Hon David


Moonie, Dr Lewis
Stott, Roger


Morgan, Rhodri
Taylor, Mrs Ann (Dewsbury)


Morley, Elliott
Taylor, Matthew (Truro)


Morris, Rt Hon J. (Aberavon)
Turner, Dennis


Mowlam, Marjorie
Vaz, Keith


Mullin, Chris
Walker, A. Cecil (Belfast N)


Murphy, Paul
Wall, Pat


Oakes, Rt Hon Gordon
Wallace, James


O'Brien, William
Walley, Joan


O'Neill, Martin
Wardell, Gareth (Gower)


Orme, Rt Hon Stanley
Wareing, Robert N.


Parry, Robert
Welsh, Andrew (Angus E)


Patchett, Terry
Welsh, Michael (Doncaster N)


Pendry, Tom
Williams, Rt Hon Alan


Pike, Peter L.
Williams, Alan W. (Carm'then)


Powell, Ray (Ogmore)
Winnick, David


Prescott, John
Worthington, Tony


Quin, Ms Joyce
Young, David (Bolton SE)


Radice, Giles



Randall, Stuart
Tellers for the Ayes:


Redmond, Martin
Mr. Ken Eastham and


Reid, Dr John
Mrs. Llin Golding.




NOES


Adley, Robert
Bright, Graham


Aitken, Jonathan
Brittan, Rt Hon Leon


Alexander, Richard
Brooke, Rt Hon Peter


Allason, Rupert
Brown, Michael (Brigg &amp; Cl't's)


Amery, Rt Hon Julian
Bruce, Ian (Dorset South)


Amess, David
Buchanan-Smith, Rt Hon Alick


Amos, Alan
Buck, Sir Antony


Arbuthnot, James
Budgen, Nicholas


Arnold, Jacques (Gravesham)
Burns, Simon


Arnold, Tom (Hazel Grove)
Burt, Alistair


Ashby, David
Butcher, John


Aspinwall, Jack
Butler, Chris


Atkinson, David
Butterfill, John


Baker, Rt Hon K. (Mole Valley)
Carlisle, John, (Luton N)


Baker, Nicholas (Dorset N)
Carlisle, Kenneth (Lincoln)


Baldry, Tony
Carrington, Matthew


Banks, Robert (Harrogate)
Carttiss, Michael


Batiste, Spencer
Cash, William


Bellingham, Henry
Chalker, Rt Hon Mrs Lynda


Bennett, Nicholas (Pembroke)
Chapman, Sydney


Benyon, W.
Chope, Christopher


Bevan, David Gilroy
Churchill, Mr


Biffen, Rt Hon John
Clark, Dr Michael (Rochford)


Blackburn, Dr John G.
Clark, Sir W. (Croydon S)


Braker, Rt Hon Sir Peter
Clarke, Rt Hon K. (Rushcliffe)


Body, Sir Richard
Colvin, Michael


Bonsor, Sir Nicholas
Conway, Derek


Boswell, Tim
Coombs, Anthony (Wyre F'rest)


Bottomley, Peter
Coombs, Simon (Swindon)


Bowden, Gerald (Dulwich)
Cope, John


Bowis, John
Cormack, Patrick


Boyson, Rt Hon Dr Sir Rhodes
Couchman, James


Braine, Rt Hon Sir Bernard
Cran, James


Brandon-Bravo, Martin
Currie, Mrs Edwina


Brazier, Julian
Curry, David





Davies, Q. (Stamf'd &amp; Spald'g)
Janman, Tim


Davis, David (Booth ferry)
Jessel, Toby


Day, Stephen
Johnson Smith, Sir Geoffrey


Devlin, Tim
Jones, Gwilym (Cardiff N)


Dickens, Geoffrey
Jones, Robert B (Herts W)


Dorrell, Stephen
Jopling, Rt Hon Michael


Douglas-Hamilton, Lord James
Kellett-Bowman, Dame Elaine


Dover, Den
Key, Robert


Dunn, Bob
King, Roger (B'ham N'thfield)


Durant, Tony
King, Rt Hon Tom (Bridgwater)


Dykes, Hugh
Kirkhope, Timothy


Eggar, Tim
Knapman, Roger


Emery, Sir Peter
Knight, Greg (Derby North)


Evans, David (Welwyn Hatf'd)
Knowles, Michael


Fallon, Michael
Knox, David


Farr, Sir John
Lamont, Rt Hon Norman


Favell, Tony
Lang, Ian


Field, Barry (Isle of Wight)
Latham, Michael


Fookes, Miss Janet
Lawrence, Ivan


Forman, Nigel
Lee, John (Pendle)


Forsyth, Michael (Stirling)
Lester, Jim (Broxtowe)


Forth, Eric
Lightbown, David


Fowler, Rt Hon Norman
Lilley, Peter


Fox, Sir Marcus
Lloyd, Sir Ian (Havant)


Franks, Cecil
Lloyd, Peter (Fareham)


Freeman, Roger
Lord, Michael


Fry, Peter
Luce, Rt Hon Richard


Gale, Roger
Lyell, Sir Nicholas


Garel-Jones, Tristan
McCrindle, Robert


Gill, Christopher
Macfarlane, Sir Neil


Glyn, Dr Alan
MacKay, Andrew (E Berkshire)


Goodlad, Alastair
Maclean, David


Goodson-Wickes, Dr Charles
McLoughlin, Patrick


Gorman, Mrs Teresa
McNair-Wilson, M. (Newbury)


Gorst, John
McNair-Wilson, P. (New Forest)


Gow, Ian
Madel, David


Gower, Sir Raymond
Major, Rt Hon John


Grant, Sir Anthony (CambsSW)
lvialins, Humfrey


Greenway, Harry (Ealing N)
Mans, Keith


Greenway, John (Ryedale)
Maples, John


Gregory, Conal
Marlow, Tony


Griffiths, Sir Eldon (Bury St E')
Marshall, John (Hendon S)


Griffiths, Peter (Portsmouth N)
Martin, David (Portsmouth S)


Grist, Ian
Mates, Michael


Ground, Patrick
Maude, Hon Francis


Grylls, Michael
Mawhinney, Dr Brian


Gummer, Rt Hon John Selwyn
Maxwell-Hyslop, Robin


Hamilton, Hon Archie (Epsom)
Mayhew, Rt Hon Sir Patrick


Hampson, Dr Keith
Mellor, David


Hanley, Jeremy
Meyer, Sir Anthony


Hannam, John
Miller, Hal


Hargreaves, A. (B'ham H'Il Gr')
Mills,Iain


Hargreaves, Ken (Hyndburn)
Mitchell, Andrew (Gedling)


Harris, David
Mitchell, David (Hants NW)


Haselhurst, Alan
Moate, Roger


Hawkins, Christopher
Monro, Sir Hector


Hayes, Jerry
Moore, Rt Hon John


Hayhoe, Rt Hon Sir Barney
Morris, M (N'hampton S)


Heathcoat-Amory, David
Morrison, Hon Sir Charles


Heddle, John
Moss, Malcolm


Heseltine, Rt Hon Michael
Neale, Gerrard


Hicks, Mrs Maureen (WoIv' NE)
Neubert, Michael


Hicks, Robert (Cornwall SE)
Newton, Rt Hon Tony


Higgins, Rt Hon Terence L.
Nicholls, Patrick


Hind, Kenneth
Nicholson, David (Taunton)


Hogg, Hon Douglas (Gr'th'm)
Nicholson, Emma (Devon West)


Holt, Richard
Onslow, Rt Hon Cranley


Hordern, Sir Peter
Oppenheim, Phillip


Howard, Michael
Page, Richard


Howarth, Alan (Strat'd-on-A)
Paice, James


Howarth, G. (Cannock &amp; B'wd)
Patnick, Irvine


Howell, Ralph (North Norfolk)
Patten, Chris (Bath)


Hughes, Robert G. (Harrow W)
Patten, John (Oxford W)


Hunt, David (Wirral W)
Pattie, Rt Hon Sir Geoffrey


Hunt, John (Ravensbourne)
Pawsey, James


Hurd, Rt Hon Douglas
Peacock, Mrs Elizabeth


Irvine, Michael
Porter, Barry (Wirral S)


Irving, Charles
Porter, David (Waveney)


Jack, Michael
Portillo, Michael


Jackson, Robert
Powell, William (Corby)






Price, Sir David
Taylor, Ian (Esher)


Raffan, Keith
Taylor, John M (Solihull)


Rathbone, Tim
Temple-Morris, Peter


Redwood, John
Thompson, D. (Calder Valley)


Rhodes James, Robert
Thompson, Patrick (Norwich N)


Riddick, Graham
Thurnham, Peter


Ridley, Rt Hon Nicholas
Townsend, Cyril D. (B'heath)


Rifkind, Rt Hon Malcolm
Tracey, Richard


Roberts, Wyn (Conwy)
Tredinnick, David


Roe, Mrs Marion
Trippier, David


Rossi, Sir Hugh
Trotter, Neville


Rost, Peter
Twinn, Dr Ian


Rowe, Andrew
Vaughan, Sir Gerard


Ryder, Richard
Waddington, Rt Hon David


Sackville, Hon Tom
Wakeham, Rt Hon John


Sainsbury, Hon Tim
Waldegrave, Hon William


Sayeed, Jonathan
Walden, George


Scott, Nicholas
Walker, Bill (T'side North)


Shaw, David (Dover)
Waller, Gary


Shaw, Sir Giles (Pudsey)
Ward, John


Shaw, Sir Michael Scarb')
Wardle, Charles (Bexhill)


Shephard, Mrs G. (Norfolk SW)
Warren, Kenneth


Shepherd, Richard (Aldridge)
Wells, Bowen


Sims, Roger
Wheeler, John


Skeet, Sir Trevor
Whitney, Ray


Smith, Sir Dudley (Warwick)
Widdecombe, Ann


Smith, Tim (Beaconsfield)
Wiggin, Jerry


Soames, Hon Nicholas
Wilshire, David


Spicer, Sir Jim (Dorset W)
Winterton, Mrs Ann


Spicer, Michael (S Worcs)
Winterton, Nicholas


Squire, Robin
Wolfson, Mark


Stanbrook, Ivor
Wood, Timothy


Stanley, Rt Hon John
Woodcock, Mike


Stern, Michael
Yeo, Tim


Stevens, Lewis
Young, Sir George (Acton)


Stewart, Allan (Eastwood)
Younger, Rt Hon George


Stewart, Ian (Hertfordshire N)



Stokes, John
Tellers for the Noes:


Sumberg, David
Mr. Robert Boscawen and


Summerson, Hugo
Mr. Mark Lennox-Boyd.


Tapsell, Sir Peter

Question accordingly negatived

New clause 8

PRESCRIPTION BY NURSES

The following sub-paragraph shall be substituted for subsection (2)(a) of section 55 of the Medicines Act 1968 (exemptions for doctors, dentists, veterinary surgeons and veterinary practitioners)
(1) to the sale or supply of all medicinal products that are not prescription only medicines, where the product is sold or supplied by a registered nurse of a category specified in an order made by the Health Ministers for the purposes of this paragraph in the course of her professional practice;
(ii) and to the sale or supply of prescription only medicines which, by virtue of an exemption conferred by an order made under section 58(4)(a), may be sold or supplied by a registered nurse of a category specified in an order made by the Health Ministers for the purposes of this paragraph, otherwise than in accordance with a prescription given by an appropriate practitioner; or".'.—[Sir David Price.]
Brought up, and read the First time.

Sir David Price: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker (Miss Betty Boothroyd): With this, it will be convenient to take new clause 9—Nursing practitioners—
'In subsection (1) of section 29 of the National Health Service Act 1977 (general medical services), there shall be

inserted the words "and nursing" after the word "medical" (both in "medical practitioners" and in "personal medical services").
The following subsection shall be inserted after subsection (8) of section 29 of the National Health Service Act 1977:
(9) Regulations may provide—
(a) for the definition, registration and remuneration of nursing practitioners;
(b) for the definition of the personal nursing services to be provided and for securing that the arrangements will be such that all persons availing themselves of those services will receive adequate personal care and attention;
(c) for conferring a right on any person to choose, in accordance with the prescribed procedure, the nursing practitioner to whom he is to be attended, subject to the consent of the practitioner so chosen and to any prescribed limit on the number of patients to be accepted by the practitioner;
(d) for any additional arrangements the Secretary of State may deem to be necessary for the adequate provision of personal nursing services.".'.

Sir David Price: New clauses 8 and 9 stand on the Notice Paper in my name and the names of a number of hon. Members who, the House will agree, cover a very wide spectrum of opinion in the House. I hope that this will make the new clauses appeal to hon. Members—[Interruption.]

Madam Deputy Speaker: Order. I wonder whether we might have a little order in the Chamber so that I can at least hear the hon. Member who is moving this motion.

Sir David Price: As I was endeavouring to tell the House, Madam Deputy Speaker, new clause 8 pertains to the power of nurses to prescribe. New clause 9 is directed towards nursing practitioners and is relevant to new clause 8. I wish to say a few words in support of each proposition. I am conscious of the desire of the House at this hour to make fairly rapid progress, so I shall endeavour to be brief.
The matter of nurse prescribing is not new. I remind the House that at present nurses have no power to prescribe even simple drugs and appliances, including pain-killers which can be bought over a pharmacist's counter. Frequently, district nurses and other nursing staff working in the community waste a considerable amount of time obtaining for their patients items such as new dressings. They must first obtain a prescription from the doctor, who may never have seen the patient in question, then obtain the item from the pharmacist, and take it back to the patient. Delays in treatment and inconvenience to patients can thus occur. Nursing time and travelling costs are wasted.
In many instances, the community nurse is, in reality, the prescriber and the general practitioner merely authorises what she advises. Similarly, many community nurses have special expertise in the care of terminally ill patients and are quite capable of using their professional judgment on matters such as varying the timing and dosage of pain-relieving drugs prescribed by doctors.
The House will be aware that the increasing development of primary health care teams is breaking down the old division between doctors, traditionally responsible for prescribing, and nurses, traditionally responsible only for administering treatment. With the recognition that individuals from different health professions can provide effective care to patients on their own, responsibility becomes a team rather than an individual approach.
I remind the House that some groups of nurses, including occupational health nurses, midwives, and some nurses in the armed forces, already have the powers that we are seeking in the new clause. We are attempting to extend to nurses the power to prescribe. That was one of the recommendations of the Cumberlege report and of our own Social Services Select Committee report. I remind the House that paragraph 61 states:
We recommend that the Government introduce legislation to permit nurses with appropriate training limited powers to prescribe and in defined circumstances to modify dosage.
In their primary health care White Paper, "Promoting Better Health", the Government responded favourably to that general proposition, stating that they will
consult the Professional Standing Advisory Committees about the professional and ethical issues of prescribing by nurses with a view to producing appropriate guidance.
The new clause offers my right hon. Friend an opportunity to respond to his own White Paper and to our recommendations. I know that there is legal discussion as to whether amendments in primary legislation are necessary.
There is a view that all we seek in the new clause can be done by my right hon. Friend under existing powers, by statutory instrument. I am advised that there is doubt about that and that it needs a change in substantive legislation. We are seeking the opportunity of the Bill to get the primary legislation put on the statute book, although the details are obviously still open to negotiation, and it would have to be implemented in the form of a statutory instrument in due course.
I hope that I have said enough at this hour to make the case for new clause 8.
I turn briefly to new clause 9, which flows from it, and again relates to the changing role of nurses. I can put the case most succinctly by quoting paragraph 59 of the Select
Committee report on primary health care, which stated:
Nurse practitioners are a relatively new concept in the UK. Other countries such as the USA and most developing countries have had such an element in their medical services for many years. In the UK there is no precise definition at present of their role. At one extreme we have been told that health centres could be run entirely by nurse practitioners. Others see nurse practitioners as more akin to health visitors or district nurses, providing a mainly preventive and health education role. It is clear that with better education of nurses and as primary health care teams develop, the role of nurses is changing fast.
It is that which has led some of my hon. Friends and myself to push the question with my right hon. Friend. He will know that in Birmingham a research project was set up in 1982 to test the hypothesis behind the concept of nurse practitioners. It was found that nurse practitioners had a valuable role in a number of areas: first, acting as an alternative consultant for the patient; secondly, screening for serious disease and abnormal physical signs and symptoms; thirdly, the management and treatment of minor and chronic ailments and injuries; fourthly, and most important, the health education of the patient; and fifthly, counselling.
As I think the House knows, the surveys which were done at the time of the Cumberlege report, and in a way for the report, supported the proposition that more of us would rather discuss our health problems with a nurse than with a doctor. I could go through the figures but the hour is late.
I hope that I have said enough to indicate that we are concerned about the development of nurse practitioners

and that we feel that they have a positive role to play in the scheme of things, particularly when there is more emphasis on care in the community, on the primary care team and, above all, on good health rather than on running just a sickness service.

Ms. Harman: I support the new clauses and thank the hon. Member for Eastleigh (Sir D. Price) for proposing them. I hope that the Government will take them as a spur to action. We have had a lot a discussion about points of controversy and agreement has been reached. The arguments in favour of limited nurse prescribing and of recognising and institutionalising the role of the nurse practitioner have been well advanced.
As the hon. Member said, with the development of care in the community the work of both the nurse prescriber and the nurse practitioner will be even more necessary. We had a debate earlier about cervical cancer screening. If the nurse practitioner were to carry out smear tests, that would be a useful role.
I hope that we shall hear from the Minister that the Government intend to take action about nurse prescribing and nursing practitioners. We want to hear about specific action, hopefully with a timetable. The discussion should move to a close and we should see action on these two important issues.

Mr. Archy Kirkwood: I echo the remarks of the hon. Member for Peckham (Ms. Harman) and congratulate the hon. Member for Eastleigh (Sir D. Price) on bringing forward the two new clauses. I was surprised to hear him say that he thought that primary legislation might be necessary. That is not my under-standing from reading the detail of the Medicines Act 1986. In sections 55(2) and 58 there seem to be prima facie powers available to the Government to carry out the proposals in the new clauses. Midwives and occupational health nurses are allowed, in certain constrained circumstances, to prescribe items from the general sales list and some prescription-only medicines. No one is suggesting that there should be anything other than careful training and limitations on the powers.
All the evidence available to the experts and commentators shows that the profession is developing substantially in that direction. To move along the lines suggested in the new clause would recognise established best practice. The matter was considered in the Cumberlege report and by the Select Committee. The primary care White Paper considered it in principle, too. There should be no difficulty about the principle of limited nurse prescription and nursing practitioners.
There is some evidence that the Government are dragging their feet somewhat on the issue. As the hon. Member for Peckham said, the purpose of the debate is to request the Government to tell us what the up-to-date situation is, and, if there are delays, to explain why they should take place. In particular, after the introductory remarks of the hon. Member for Eastleigh, the Government should tell us whether primary legislation is required. Obviously, the implementation of any schemes will be postponed until parliamentary time is available.
Had the hour been earlier, we could have had a much more substantial debate on the detail and practice that are to be worked out. On that basis, my right hon. and hon. Friends and I support the principle and the need to develop the practice and to implement the new clauses.

Mr. Newton: I congratulate my hon. Friend the Member for Eastleigh (Sir D. Price) on moving the new clause, even though I hope that he will not press it too far.
Indeed, I recall one of my early indiscretions, within a day or two of being appointed to my present position. On the radio I stated that nurse prescribing sounded rather a good idea, which caused quite a fit when I got back to the Department that morning. My view that it is rather a good idea has been strengthened in the intervening period. As my hon. Friend will know—we referred to this matter in the primary health care White Paper—we saw merit in giving nurses more freedom to prescribe a limited range of items, such as dressings, ointments and medical sprays, and to exercise their professional judgment on the timing and dosage of drugs prescribed by doctors for the relief of pain. It is not a matter of foot dragging, to pick up the point that was made by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). We have not reached the point at which we can say, "This is what nurses should be able to prescribe and this is how the arrangements will work." But I am glad to be able to report to the House some further progress, which I hope will go further fairly soon.
Following an initial approach to the professional standing advisory committees—in the White Paper, we stated that we would do that—we are in the process of setting up a joint working party to examine the professional and ethical issues of nurse prescribing. We expect the working party to begin work next month. I hope that that will give the House some encouragement.
Frankly, it is not possible to say—I pick up some other remarks of my hon. Friend and the hon. Gentleman—what, if any, legislative implications there will be, because we need to examine the work of the working party first. It is clear that we can do several things without primary legislation, but I could not put my hand on my heart and say that it is absolutely certain that all that one might want to do can be done without primary legislation.

Ms. Harman: Who is on the working party, and what will be the representation of nurses on it?

Mr. Newton: I cannot answer that question without notice, I am afraid. Should an appropriately armed carrier pigeon arrive from a certain quarter in the next moment or two, I shall see whether I can get the message off its leg. Otherwise, I shall see what information can be provided to the hon. Lady and, indeed, to other hon. Members by some other means.
I have to be just a fraction less forthcoming about the concept of nurse practitioners. [Interruption.] Before dealing with that, however, I shall return to nurse prescribing. I cannot give names, but the answer to the question asked by the hon. Member for Peckham (Ms. Harman) is that there will be three nurses from the standing nurses' and midwives' advisory committee, two pharmacists from the standing pharmaceutical advisory committee and two doctors from the standing medical advisory committee, plus a chairman. Therefore, while it would not be quite right to say that the nurses will have a majority, there will be more of them than of anyone else, and I think that that position will be regarded as reasonable.
12 midnight
I am equally sympathetic to the general principle of nurse practitioners, as the White Paper and the circular

that the Government issued following the Cumberlege report suggested, but it is a more difficult subject because, as my hon. Friend the Member for Eastleigh acknowledged by implication—or perhaps even explicitly—in his remarks, the concept is not frightfully well defined. Our first problem, therefore, is to define exactly what we mean by the phrase "nurse practitioner" which we all tend to use in rather generalised terms. The Department is continuing work—again not with the aim of dragging its feet—with a view to deciding how best the work of agreeing a clearer definition can be carried forward with the professions. I shall certainly ensure that that work is undertaken as fast as it reasonably can be, but I cannot say much more this evening.
I hope that I have conveyed to the House the Government's continuing sympathy for the concepts, the further progress that we hope to make fairly rapidly in relation to nurse prescribing and the fact that we have by no means forgotten the concept of the nurse practitioner.

Sir David Price: I thank my right hon. Friend for that reply. I was encouraged by what he had to tell the House about the working party. I hope that he will be able to persuade it to put a time limit on its discussions, because there is nothing like a time limit to settle the mind. I can imagine the various bodies concerned going on indefinitely, and I hope that my right hon. Friend will get them to agree at their first meeting a time by which they will report. I shall, of course, expect my right hon. Friend to tell us the results. He will certainly have our support if any primary legislation is needed, although I very much hope that provision can be made by statutory instrument under existing legislation.
I am encouraged by what my right hon. Friend said about new clause 9, to which I also spoke. It is rather urgent to get a proper definition because the subject has a bearing on the future supply of nurses, nurses' career structure and training and, ultimately, pay for extra responsibility for nurses. The concept is therefore relevant. In considering demographic forecasts of the number of young people with the necessary qualifications coming out of our schools, we must take more very much more seriously than hitherto the optimisation of nurses' professional qualifications. The concept of the nurse practioner is primarily directed towards that.
With those few remarks, I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.

New clause 17

COMPLAINTS (DEPARTMENTAL HOSPITALS)

(1) Subject to subsection (2) below, the provisions of the Hospital Complaints Procedures Act 1985 shall apply to hospitals directly managed by the Department of Health and Social Security as though they were managed by a health authority.
(2) The Secretary of State shall, after consulting such bodies as appear to him to represent the interests of the public within the National Health Service, by order made by statutory instrument establish Regulations for the application of the provisions of that Act to enable it to apply to those hospitals.
(3) A statutory instrument under subsection (2) shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.—[Mr. Fearn.]
Brought up, and read the First time.

Mr. Fearn: I beg to move, That the clause be read a Second time.

Madam Deputy Speaker: With this it will be convenient to discuss new clause 19—Complaints ( Ministry of Defence Hospitals)
`—(1) Subject to subsection (2) below, the provisions of the Hospital Complaints Procedures Act, 1985, shall apply to hospitals managed by the Ministry of Defence as though they were managed by a health authority;
(2) The Secretary of State for Defence shall, after consulting such bodies as appear to him to represent the interests of the public within the National Health Service, by order made by statutory instrument establish Regulations for the application of the provisions of that Act to enable it to apply to those hospitals;
(3) A statutory instrument under subsection (2) shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.

Mr. Fearn: The Hospital Complaints Procedures Act 1985 has the potential to be a very useful piece of legislation. It is unfortunate that we are still awaiting its implementation and that consultation on the details of its implementation has taken so long. Perhaps the Minister will be able to report some progress in his reply. However, one limitation that has seemed to me unnecessary has been the restriction of its operation to hospitals managed by health authorities.
The new clauses seek to extend the terms of the Act to two other kinds of hospital. New clause 17 would extend the legislation to cover hospitals directly managed by the DHSS. These are the special hospitals, and the top security Park Lane hospital, which I recently visited, is one such hospital. The work of the Mental Health Act Commission is of great importance in this context, but it still seems appropriate to include provision for management to take action in the same way as the management of health authorities are required to take action in mainstream hospitals.
New clause 19 would extend the legislation to cover Ministry of Defence hospitals. As far as I can see, there is no justification for saying that an NHS patient who is receiving treatment in such a hospital, probably as a result of an NHS arrangement, should not be accorded the same rights as other NHS patients.
The new clause enables anyone to debate the rights of service men who complain about things that could go wrong. It seems entirely wrong that a member of the armed services should have inadequate protection against problems that have nothing whatever to do with his employment. The problems covered by the new clause are cases in point. At this stage there is a need to be prescriptive on that more general issue. The matter can be debated before the regulations are laid under the new clause.
The Government should have no difficulty in accepting these proposals. We are sure that the Government do not reject the view that all patients should have equal rights, without arbitrary distinction.

Mrs. Currie: As the hon. Member for Southport (Mr. Fearn) said, his new clause seeks to apply the provision of directions issued under the Hospital Complaints Procedure Act 1985. He may know that I was associated with that Act, because, as a Back Bencher, among other things, I took it through the House on Third Reading. I agree with the hon. Gentleman's implication that it is a useful and valuable piece of legislation.
We are about to issue a circular to the National Health Service. It has been delayed to secure final consultation with the Health Service Commissioner, the ombudsman, and the joint consultants' committee. Comments have been received and it is planned shortly to issue the circular under that legislation. Very minor modifications to the text of the circular are being made. It is expected that the directions will come into effect possibly in June or July. Of course sufficient time must be given for the health authorities to prepare for their responsibilities under the Act.
New clause 17 is unnecessary. The directions will apply to hospitals managed by the Department of Health and Social Security. They will be required to follow the provisions of the Act in exactly the same way as hospitals in the National Health Service. Therefore, it is not necessary to establish a separate statutory instrument for the special hospitals. They will be covered by the Act, the circular and the directions that we are about to issue.
New clause 19 deals with Ministry of Defence hospitals. Each hospital for which the Ministry of Defence is responsible already has well established procedures under which complaints may be made by or on behalf of patients at that hospital. These complaints are taken very seriously and are thoroughly investigated either locally or by the Ministry of Defence itself. Booklets explaining these procedures are supplied to patients on admission to hospital and notices giving information on the complaints procedures are displayed in out-patient areas at each hospital.
Although Ministry of Defence hospitals do not come within the provisions of the National Health Service Act 1946, the Ministry's complaints procedures were reviewed in the light of the provisions of the Hospital Complaints Procedures Act. It was concluded at that time that while the provisions of the Act were not binding on the Ministry of Defence, they had already been implemented by the Ministry. My right hon. Friend the Secretary of State for Defence tells me that he is satisfied that these arrangements ensure that patients treated in Ministry of Defence hospitals have adequate means by which to make complaints. On that basis, we feel that new clause 19 is also unnecessary and the hon. Gentleman might not wish to press it.

Mr. Fearn: In view of what the Minister said, I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.

New clause 18

ALLOWANCES

'(1) It shall be a duty of the Secretary of State for Scotland to allot to each Health Board, after consultation with that board and with such bodies as appear to him to represent the interest of the public in the area of the Board within the National Health Service, an additional allocation sufficient to meet the cost of allowances paid pursuant to subsection (2).

(2) The Secretary of State shall by order made by Statutory Instruments provide that allowances in addition to any allowances otherwise payable be paid to general medical practitioners satisfying criteria:

(a) in respect of the density of the population served in the area served by the practise, or part of such area;
(b) in respect of the number of principals and assistants practising therein;
(c) in respect of such other considerations as seem to him to be appropriate.

(3) A Statutory Instrument under subsection (2) shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.—[Mr. Kirkwood.]

Brought up. and read the First time.

Mr. Kirkwood: I beg to move, That the clause be read a Second time.
I should explain the purpose of the new clause from the outset because its wording does not make it as clear as it might be. It is an attempt to focus attention briefly on the plight and potential difficulties faced by rural practitioners in Scotland.
Rural practitioners have problems throughout the length and breadth of the United Kingdom, but I think that the House would accept that, given the geographical disparate nature of large sections of the Scottish mainland, it is appropriate to focus attention specifically on the problems of rural practitioners in Scotland.
The problems faced by general practitioners in Scotland relate, as much as anything else, to the question of list size. We know that the United Kingdom target is an average list size of 1,700 for general practitioners. In Scotland that is the average list size but the figure is due largely to the number or rural practitioners in the highlands and islands who have extremely small lists because of the nature of the geographical area they cover. In our urban and deprived inner city areas the list sizes remain too high and there is a need for more general practitioners.
I had an interesting answer to a question that I tabled some time ago. It gave the number of small practices in Scotland. I was told that at 1 October 1986, the latest date for which information was available, there were 779 doctors with a list size of less than 1,000, 982 with a list size of less than 1,200 and 1,316 with a list size of less than 1,500. Therefore, there is a difficulty about the list size in rural practices.
Having a large number of rural practices—often single-handed practices—with such small lists there are certain peculiar difficulties for the doctors. The proposals contained in the new clause and the thinking behind it seek to redress some of the working conditions they face, particularly the direct reimbursement of local allowances for GPs taking study leave, the introduction of functional group allowances and special assistance to enable doctors to take on a partner. That is the background and provenance of the new clause.
I was prompted to table the clause, having received a letter from a Dr. Macleod in Inverness, whose permission I sought to advise the House of the contents of the letter he sent earlier this year. He said:
We have a relatively small list, so have never expected to make as much money as most of our colleagues. We have, however, time to give to our patients. We cover an area from Smithton to Brodie and Dulcie Bridge to Fort George. Our practice area includes the high risk areas of Dalcross Airport, McDermotts (Scotland)"—
which is a fabrication and construction yard—
and the A96. For the convenience of our patients we operate branch surgeries in Croy and Nairn. We have patients in the local GP hospital and cover there for casualty. We have a Recall System for cervical smears and a Call Up system for immunisations. We provide a Well Woman Clinic and a Well Man Clinic. We undertake some minor surgery. We have a policy of regularly visiting our elderly patients. To avoid the unacceptable delays experienced elsewhere we have not operated an appointments system. We are each available for consultation for an average of 75 hours per week and many more during normal holiday periods. We do not delegate any of our work to deputies. We are a teaching practice.

We think we run a good practice. Geographically there is no scope for increasing our list size. For whatever reason, the patient demand is increasing well beyond that which one would expect from the pathology exhibited.
In recognition of all this the proposals on list size in the White Paper will cut our income by something between £4,000 and £11,500.
During discussions with Dr. Macleod it became clear that the implications for some practices in Scotland, which are small by United Kingdom standards, were severe indeed. I wonder whether the Government understand the full implications of their proposals.
The new clause aims to make a reality of what the Government claim as being their target in their White Paper, "Promoting Better Health," to try to help rural areas. Far from helping rural areas, cash limiting general practices and plans to increase the size of lists and surgery hours before they qualify for basic practice allowances will have a devastating effect, particularly in Scotland. Under the new clause, the Secretary of State for Scotland would be forced to take into account the large number of rural practices, which are often single-handed practices.
12.15 am
GPs who work in isolation, such as Dr. Macleod and his colleagues, must spend more time working for their patients than their urban colleagues because of increased travelling and home visiting. They have little contact with colleagues and experience difficulty in obtaining time off. Rural GPs often play a wider role, as I know from my constituency work, by substituting for other services that are lacking in rural areas.
The new clause would require an additional allocation to be made, which would include inducement payments to cover the cost of employing high-calibre partners, study leave and improvements to surgery and medical facilities. This would ensure that GPs and their patients in isolated areas do not suffer professionally.
Rural primary care saves resources by prevention and treatment in the community. The Government do not understand this matter and do not appreciate the needs and difficulties of isolated practices. If the new clause were to be accepted, it would go some way to addressing those problems and to improving health care for people in remote communities.
I understand that some of these subjects are being discussed and that the Government are still considering what to do to confront the problems. I urge the Minister—a man for whom I have a high regard, even in Scottish matters—to take these matters seriously and to ensure that we get a fair deal and proper allocation for GP services in rural areas.

Mr. Malcolm Bruce: I support the new clause, because it relates to a matter about which I have received representations. The Minister should give attention to those representations.
The matter has been brought to my attention by a single-handed practitioner in my constituency who has been trying to promote the collective development of his practice along with neighbouring single-handed practioners—one in my constituency and two in the constituency of the right hon. Member for Kincardine and Deeside (Mr. Buchanan-Smith). He has been suggesting that it would be much better for individual practices and their patients to join forces to recruit a partner to the four practices to provide cover when the GPs are away on study leave or holiday.
The obvious advantage is that patients would know the doctor standing in for their normal doctor in a way that they could not know a locum who has been brought in for short-term purposes. I think that the Minister will acknowledge that what tends to happen is that patients suddenly manage to contain their illness when their doctor is away, unless it is desperately urgent. When their doctor returns from study leave or holiday, he has a huge queue of patients who were not willing to see a locum whom they did not know. That is the essence of human nature and I think that the Minister will understand that that is what happens.
It seems to me that the proposal of that practitioner and his colleagues is sensible and practical. It will help his practice, neighbouring practices and patients. Yet so far he has been unable to get support from the Scottish Office for his suggestion.
When I first raised the matter with the Scottish Office, officials replied that they were not able to support the proposal because it was likely to be rather more expensive to operate than allowing each individual practitioner to retain his own locum. I then asked the Scottish Office to give an indication of the breakdown of costs, and the officials said that they had analysed the costs and there was no significant difference between supporting the doctors' wishes and simply requiring them to continue with the existing practice of hiring locums as and when they needed them.
We managed to debunk the argument that it would necessarily cost more, although the new clause states that, even if there is a cost, it should be supported. In spite of having proved that particular point, the Scottish Office continues to resist this practical and constructive suggestion.
I am sure that the situation is not peculiar to Scotland. There are parts of England to which this suggestion would be relevant and helpful. I have been mystified as to why it has been resisted so far, as indeed have the doctors in question, who feel that they are making a constructive suggestion in the best interests of their own working practices and of their patients.
I believe that the new clause is sensible and constructive. It will not necessarily lead to enormous costs, and it will ultimately ensure that there is good health provision in thinly populated areas.
It is not always easy to get dedicated doctors to come to rural areas and operate a single-handed practice. Only a particular type of doctor is willing to take that on. Doctors have come in and have not survived. Within a year or two they have felt unable to sustain the practice. With no disrespect to the doctors who have come to rural areas, it is interesting to note that two of the four practitioners that I mentioned are not British. They are very good doctors, they are very welcome and we are very glad to have them, but that situation is indicative of how difficult it is to attract people into those practices. The new clause would go a long way towards maintaining viable practices, ensuring that practitioners can have some relief from the constant pressure and can work with neighbouring practitioners in a constructive and helpful way.
I hope that the Minister will take on board this suggestion. If he cannot accept the new clause tonight—we understand that—I hope that he will undertake to consider

the thinking behind it and come back at a later stage having considered it. The proposals are constructive and serious and certainly should not be rejected out of hand.

Mr. Galbraith: When I first read the new clause, I was unclear as to its exact intent, but, having heard the explanation, its purpose is now clear to me. I am not sure that the new clause would fulfil all its intentions. Heaven forbid that amateur drafters such as ourselves should always be able to do that. However, the intention is excellent and we should like to record our support of it.
It is a problem in rural areas, particularly in the highlands and islands and other parts of Scotland, but I am sure that it is also an important issue for some parts of England. A constant problem that affects general practitioners and surgeons who are on continuous 24-hour call for seven days a week is the inability to get away and go to postgraduate meetings. I realise that the new clause applies not to hospital doctors working single-handedly but only to general practitioners, but the principle is extremely important.
Numerous ways have been considered to give doctors working in such practices time off so that they can keep tip to date with what is happening in medicine and have some relief from being on call for 24 hours. When they go home at night, they never know whether they will have to go out again. There is no respite from the continual ringing of the telephone. Various methods have been tried, and a roving practitioner was used for a while, but that did not really work.
The purpose behind the new clause is that money should be provided for various things that general practitioners now have to provide for themselves. My hon. Friends and I support the new clause.

Mr. Newton: I have to confess that the Government and I collectively face the same difficulty as was experienced by the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith)—that we had not spotted the purpose of the new clause. Most of my brief is therefore scrap paper. I do not think that a carrier pigeon will come to my rescue on this occasion.
I am encouraged by what has been said about the new clause. We thought that it amounted to a general attack on the system of reimbursing general practitioners that was proposed in the White Paper, but I now understand it to be a perfectly rational suggestion about how the system should be geared to meet the particular problems of particular areas. The suggestion is just as relevant to some parts of England as it is to some parts of Scotland.
The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) kindly said that he would understand if I was unable to accept the new clause. I am unable to do so, but I shall ensure that the points that he has made are sympathetically considered. It is not for me to commit the Scottish Office, but I have no doubt that my colleagues there will want to study what has been said, and I undertake to do so in relation to England.
I hope that it will be encouraging if I point to two quite clear-cut references in the White Paper to our awareness of the problem. I shall not weary the House by reading them at length, but paragraph 3.38, which refers to the possible introduction of a new allowance for areas of deprivation, goes on in the next sentence to say:


The effect of these arrangements will be examined and if necessary other changes in the remuneration system will be introduced, for instance to help doctors in sparsely populated areas.
Paragraph 3.39, which is side-headed "Rural Areas," deals with the extent to which doctors, especially those who practise single-handed in rural areas, can be affected by a number of factors that can contribute to professional and social isolation. The final sentence reads:
To take account of the particular pressures on these doctors, the Government will examine, in consultation with the profession, the scope for introducing measures aimed at alleviating their social and professional isolation, for example so that they may have more opportunities to attend post-graduate courses.
I hope that the spirit of those positive commitments in the White Paper, which are very much in line with the generality of what hon. Members have been urging on me, demonstrates that the Government are willing to look seriously at the points that they have raised.

Mr. Kirkwood: We have stumbled on a new tactic. If the Minister is naturally a fairly reasonable chap, the obvious tactic is to table a completely incomprehensible amendment that he has to think through for himself and to which he then, without any help from his civil servants, has to respond. It is a ploy that can be developed and used on future occasions.
I appreciate what the Minister said, but at the risk of appearing churlish I hope that he will not mind if I press the new clause to a Division. It will demonstrate the importance that we attach to the subject. I understand that conversations are to take place, but a Division may help to concentrate people's minds. I propose therefore to press the new clause to a Division.

Question put, That the clause be read a Second time:—
The House divided: Ayes 43, Noes 194.

Division No. 257]
[12.30 am


AYES


Ashdown, Paddy
Lloyd, Tony (Stretford)


Beith, A. J.
McAvoy, Thomas


Brown, Nicholas (Newcastle E)
McFall, John


Bruce, Malcolm (Gordon)
McKay, Allen (Barnsley West)


Campbell, Menzies (Fife NE)
McLeish, Henry


Campbell, Ron (Blyth Valley)
Marshall, Jim (Leicester S)


Campbell-Savours, D. N.
Michie, Mrs Ray (Arg'l &amp; Bute)


Carlile, Alex (Mont'g)
Morgan, Rhodri


Cook, Robin (Livingston)
Morley, Elliott


Corbyn, Jeremy
Mowlam, Marjorie


Cummings, John
Pike, Peter L.


Cunliffe, Lawrence
Robertson, George


Dunnachie, Jimmy
Rooker, Jeff


Ewing, Mrs Margaret (Moray)
Salmond, Alex


Galbraith, Sam
Skinner, Dennis


Graham, Thomas
Spearing, Nigel


Harman, Ms Harriet
Steel, Rt Hon David


Henderson, Doug
Turner, Dennis


Hinchliffe, David
Walley, Joan


Hogg, N. (C'nauld &amp; Kilsyth)
Wareing, Robert N.


Hood, Jimmy



Hughes, John (Coventry NE)
Tellers for the Ayes:


Hughes, Simon (Southwark)
Mr. Archy Kirkwood and


Lewis, Terry
Mr. Ronnie Fearn.




NOES


Allason, Rupert
Arnold, Tom (Hazel Grove)


Amess, David
Ashby, David


Amos, Alan
Atkinson, David


Arbuthnot, James
Baker, Rt Hon K. (Mole Valley)


Arnold, Jacques (Gravesham)
Baldry, Tony

Batiste, Spencer
Hughes, Robert G. (Harrow W)


Bellingham, Henry
Hunt, David (Wirral W)


Bennett, Nicholas (Pembroke)
Hunt, John (Ravensbourne)


Body, Sir Richard
Irvine, Michael


Bonsor, Sir Nicholas
Jack, Michael


Boswell, Tim
Janman, Tim


Bowden, Gerald (Dulwich)
Jessel, Toby


Bowis, John
Jones, Gwilym (Cardiff N)


Brandon-Bravo, Martin
Jones, Robert B (Herts W)


Brazier, Julian
King, Roger (B'ham N'thfield)


Bright, Graham
Kirkhope, Timothy


Brittan, Rt Hon Leon
Knapman, Roger


Brooke, Rt Hon Peter
Knight, Greg (Derby North)


Buck, Sir Antony
Knowles, Michael


Burns, Simon
Latham, Michael


Burt, Alistair
Lawrence, Ivan


Butcher, John
Lee, John (Pendle)


Butler, Chris
Lennox-Boyd, Hon Mark


Carlisle, Kenneth (Lincoln)
Lester, Jim (Broxtowe)


Carrington, Matthew
Lightbown, David


Carttiss, Michael
Lilley, Peter


Cash, William
Lloyd, Peter (Fareham)


Chapman, Sydney
Lord, Michael


Chope, Christopher
Luce, Rt Hon Richard


Clarke, Rt Hon K. (Rushcliffe)
Lyell, Sir Nicholas


Colvin, Michael
Maclean, David


Conway, Derek
McLoughlin, Patrick


Coombs, Anthony (Wyre F'rest)
McNair-Wilson, P. (New Forest)


Coombs, Simon (Swindon)
Madel, David


Couchman, James
Malins, Humfrey


Cran, James
Mans, Keith


Currie, Mrs Edwina
Marshall, John (Hendon S)


Curry, David
Martin, David (Portsmouth S)


Davis, David (Boothferry)
Mates, Michael


Day, Stephen
Mawhinney, Dr Brian


Devlin, Tim
Maxwell-Hyslop, Robin


Dorrell, Stephen
Mayhew, Rt Hon Sir Patrick


Douglas-Hamilton, Lord James
Meyer, Sir Anthony


Dover, Den
Miller, Hal


Dunn, Bob
Mills, Iain


Durant, Tony
Mitchell, Andrew (Gediing)


Dykes, Hugh
Mitchell, David (Hants NW)


Eggar, Tim
Monro, Sir Hector


Evans, David (Welwyn Hatf'd)
Moore, Rt Hon John


Fallon, Michael
Morrison, Hon Sir Charles


Favell, Tony
Moss, Malcolm


Forman, Nigel
Neubert, Michael


Forsyth, Michael (Stirling)
Newton, Rt Hon Tony


Forth, Eric
Nicholls, Patrick


Fox, Sir Marcus
Nicholson, David (Taunton)


Franks, Cecil
Nicholson, Emma (Devon West)


Freeman, Roger
Onslow, Rt Hon Cranley


Gale, Roger
Page, Richard


Gill, Christopher
Paice, James


Goodhart, Sir Philip
Parkinson, Rt Hon Cecil


Goodson-Wickes, Dr Charles
Patnick, Irvine


Gorman, Mrs Teresa
Patten, John (Oxford W)


Gorst, John
Pattie, Rt Hon Sir Geoffrey


Gow, Ian
Peacock, Mrs Elizabeth


Greenway, John (Ryedale)
Portillo, Michael


Gregory, Conal
Price, Sir David


Griffiths, Peter (Portsmouth N)
Rattan, Keith


Grist, Ian
Rathbone, Tim


Ground, Patrick
Redwood, John


Gummer, Rt Hon John Selwyn
Riddick, Graham


Hamilton, Hon Archie (Epsom)
Roberts, Wyn (Conwy)


Hampson, Dr Keith
Roe, Mrs Marion


Hanley, Jeremy
Ryder, Richard


Hargreaves, A. (B'ham H'll Gr')
Sainsbury, Hon Tim


Hargreaves, Ken (Hyndburn)
Sayeed, Jonathan


Harris, David
Shaw, David (Dover)


Haselhurst, Alan
Shephard, Mrs G. (Norfolk SW)


Hayes, Jerry
Sims, Roger


Heddle, John
Smith, Sir Dudley (Warwick)


Hind, Kenneth
Smith, Tim (Beaconsfield)


Holt, Richard
Spicer, Sir Jim (Dorset W)


Howard, Michael
Stanbrook, Ivor


Howarth, Alan (Strat'd-on-A)
Stanley, Rt Hon John


Howarth, G. (Cannock &amp; B'wd)
Stern, Michael


Howell, Ralph (North Norfolk)
Stevens, Lewis

Summerson, Hugo
Ward, John


Taylor, Ian (Esher)
Warren, Kenneth


Thompson, D. (Calder Valley)
Wells, Bowen


Thompson, Patrick (Norwich-N)
Wheeler, John


Thurnham, Peter
Whitney, Ray


Townsend, Cyril D. (B'heath)
Widdecombe, Ann


Tredinnick, David
Wilshire, David


Trippier, David
Winterton, Mrs Ann


Trotter, Neville
Winterton, Nicholas


Twinn, Dr Ian
Wood, Timothy


Vaughan, Sir Gerard



Waddington, Rt Hon David
Tellers for the Noes:


Wakeham, Rt Hon John
Mr. Robert Boscawen and


Walden, George
Mr. Tristan Garel-Jones.

Question accordingly nagatived

New clause 22

ALLOCATION TO REGIONAL HEALTH AUTHORITIES

`It shall be a duty of the Secretary of State each year to
allocate to each Regional Health Authority and to each Family Practitioner Committee in England an allocation sufficient to meet the costs of existing services, including the increase in costs arising from pay rises and price inflation on National Health Service purchases.'.—[Mr. Fearn.]

Brought up, and read the First time.

Mr. Fearn: I beg to move, That the clause be read a Second Time.
New clause 22 seeks to establish the principle that the Government have a duty to maintain the funding of the NHS at least in real terms. That has not happened in the past. Despite Government rhetoric, often at its most strident during Prime Minister's Question Time, the fact is that the NHS is suffering from cumulative underfunding over the years.
For example, the Government have repeatedly argued that their so-called efficiency savings are the same as providing new money for the NHS. That is palpably untrue. The repeated failure of the Government fully to fund NHS pay awards to which they have consented and their failure to recognise the full effect of price rises in NHS supplies have meant that health authorities have been squeezed. People working on the ground know from their own experience that the Government's claims do not reflect reality.
Moreover, there are particularly regional problems. The principle of equalising the level of health service available throughout the country is correct, but whereas the resource allocation working party strategy was established on the assumption that the provision would be levelled up, the Government have turned it into a matter of robbing Peter to pay Paul.
The new clause would prevent the worst effects of Government policy. I should have liked to write into the new clause a duty for the Government to fund the additional demands for services from the increasing number of elderly people in the population and for improving clinical techniques, generally estimated at about 2 per cent. per year at present. However, the drafting of such a provision would inevitably be complex and almost certainly flawed. Therefore, I have compromised by including the words "at least".
The formula set out in the new clause is not intended as a ceiling; it is merely a floor. The purpose of the new clause parallels that of the so-called Rooker-Wise amendment for personal taxation. It sets a basic demand for NHS funding, any breach of which would require primary legislation. We believe that the extra protection which would result from the fear of adverse publicity will protect the NHS

generally, and each regional health authority and family practitioner committee in particular, from the worst potential effects of Government policies. I commend the clause to the House.

Mrs. Currie: One effect of the new clause would be to impose on the Secretary of State a statutory obligation to anticipate the effects of NHS pay and price inflation in determining the financial allocations to regional health authorities and family practitioner committees. No sensible employer would ever guarantee to pay in advance all and any pay bill without knowing what it amounted t o. We await the reports of the review bodies on pay, and when they have reported and the various details have been gathered in my right hon. Friend the Prime Minister will make a statement.
Generally speaking, the hon. Gentleman should be aware that the new clause, which we reject, would signal a return to volume planning throughout the public sector. The success of the Government's medium-term financial strategy, in particular the reduction of public expenditure as a proportion of gross domestic product, is based on the discipline of cash planning and the adherence, wherever possible, to cash limits.
12.45 am
If accepted, the clause would reduce the Government's flexibility in reaching decisions on public expenditure programmes as a whole by pre-empting money for the health services ahead of, for example, programmes for pensions, and would remove the cash planning controls that have been such a successful feature of the Government's management of the economy.
In any event, the clause is not practicable. The effects of pay and price inflation cannot be measured until after the end of the financial year in question. My right hon. Friend the Secretary of State could, therefore, perform the statutory duty that would be imposed on him by the clause only by ensuring a substantial margin of over-provision.
There has been concern about the uncertainty created because health authorities enter the financial year before the review body recommendations are finalised. We have responded to that. As the Chief Secretary to the Treasury announced on 24 February, the Government are taking steps to change the timetable from 1989 for deciding the pay review body awards to provide greater certainty for health authorities when they draw up their budgets. We hope that decisions on the 1988 awards will be macle shortly, but in future years the timetable will be brought forward and we hope that decisions will be announced by the end of January.
The basis of the Government's economic strategy to which I have just referred has given us the low inflation and rapid growth which have enabled us to fund the National Health Service to record levels, to employ record numbers of staff and to look after record numbers of patients, both inside and outside the hospital service.
The new clause is uncalled for and not practicable, and I urge the House to reject it.

Question put and negatived.

New clause 23

ACCESS TO INFORMATION

'(1) Subject to subsection (2) below, the provisions of the Local Government (Access to Information) Act 1986, shall apply to Regional Health Authorities, District Health Authorities, Health Boards, Special Health Authorities and boards of Governors as they apply to local authorities.

(2) The Secretary of State shall by order made by statutory instrument establish regulations for the interpretation of the provisions of the Local Government (Access to Information) Act to the extent that is necessary for the Act to apply to the bodies specified in subsection (1).

(3) A statutory instrument under subsection (2) shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.—[Mr. Fearn]

Brought up, and read the First time.

Mr. Fearn: I beg to move, That the clause be read a Second time.
The clause seeks to bring open government into the Health Service. Health authorities spend billions of pounds of public money and comprise people of whom only a small minority are directly accountable to the public. The formal accountability to Parliament, through the Secretary of State, is remote and capable of being enforced only in a pinprick manner.
The clause seeks to establish a less formal but more effective form of public accountability, achieved by publicity. There is no justification for Health Service decisions being taken behind closed doors, except in the circumstances recognised by the Local Government (Access to Information) Act 1985.
At present, different health authorities have different traditions of openness or otherwise, but in too many cases it remains the case, as used to apply in some local authorities, that administrative convenience or the wish to avoid embarassment is the real reason for choosing to debate an issue in private session.
I have noted the private Member's Bill of the hon. Member for Warley, East (Mr. Faulds), which makes similar provision in respect of community health councils. That is fine so far as it goes, especially if the Government are prepared to fund the additional costs which community health councils will incur, but management decisions are taken by health authorities. The public needs access to the proceedings and documents of the health authorities.
It is a principle, therefore, of good administration that decisions affecting people's lives should be taken in an open manner and that decisions on the spending of public money should be taken in public. It is that principle that the clause seeks to put into effect.

Mr. Newton: In saying why the Government do not feel able to accede immediately to the request of the hon. Member for Southport (Mr. Fearn), I wish to make the position as clear as possible. As I am sure he is aware, health authorities are already subject to the Public Bodies (Admission to Meetings) Act 1960.

Mr. Norman Hogg: Does the Minister know who put that on the statute book?

Mr. Newton: I know who was in the Government in 1960—

Mrs. Currie: It was our right hon. Friend the Member for Finchley (Mrs. Thatcher).

Mr. Newton: —but I had not realised that it was my right hon. Friend the Prime Minister who put that measure on the statute book. That persuades me even further that it must have been a splendid Act.
The 1960 Act applies to health authorities and it requires them to give public notice of the time and place of the meeting with a notice on the door of the health authority office. Secondly, it requires them to supply copies of the agenda to any newspaper that requests it.Beyond that, some health authorities—although we are not sure that this is true of all—routinely send out agendas to newspapers and local radio. Thirdly, under the 1960 Act, they are required to open the meeting to the public.
The slight impression that the hon. Member for Southport conveyed of all health authorities operating without any constraint in a completely hole-and-corner fashion was something of an exaggeration.

Mr. Jeremy Corbyn: Is the Minister aware that some health authorities regularly and routinely use the procedure of going into private session to discuss what are supposed to be private matters but which in some cases are matters that should be dealt with in the public domain? While I recognise that individual patients' rights must be discussed in private, does the Minister concede that there is a case for examining more closely the propensity of health authorities to go into private session to discuss financial matters which should be brought into the public domain?

Mr. Newton: I was going to conclude by saying that I would certainly not rule out the possibility of giving further consideration to this matter. However, the new clause was tabled only on Monday and therefore appeared on the amendment paper on Tuesday, Frankly, we have not had a great deal of time to consider its implications which could be quite substantial.
I was about to say that if the new clause was accepted, alongside or in addition to the duties that health authorities already possess in respect of public notice and public attendance at meetings, there would be added the following obligations. First, reasons would have to be given for closing a meeting, or part of it, to members of the public. I accept that that is not an unreasonable proposition. Secondly, copies of agendas and reports would have to be open for inspection by members of the public in advance. Thirdly, copies of minutes, agendas and reports would have to be available after the meeting for public inspection for six years. Fourthly, copies of background papers would have to be available for public inspection for four years. Finally, all the four items that I have just mentioned would also apply to sub-committees.
I would not care to rule out one of those conditions within the circumstances of our discussions tonight as a matter of principle. However, the implications, including the administrative implications and the possible costs, are considerable. They would properly need to be carefully considered as there are so many other demands on the resources available to health authorities. I cannot advise the House to accept the new clause tonight.
I want to refer to the point made by the hon. Member for Southport about community health councils. As he said, there is a private Member's Bill before the House at present concerned with applying the provisions in the Local Government (Access to Information) Act 1985 to community health councils. Community health councils,


as the representatives of the public in an area, have substantial powers under regulations to receive information from health authorities. That is relevant when we consider how far health authorities can operate in the kind of hole-and-corner fashion to which the hon. Member for Southport referred.
Although I do not feel able, for the reasons that I have given, to advise the House to accept the new clause, I would not rule out further consideration being given to the matter. However, I would not promise that consideration being given at a particular time, for example, during later stages of the Bill.

Mr. Fearn: In view of what the Minister has said, I beg to ask leave to withdraw the clause.
Motion and clause, by leave, withdrawn.

Clause 1

VESTING OF PROPERTY ETC. OF CORPORATION IN A COMPANY NOMINATED BY THE SECRETARY OF STATE AND DISSOLUTION OF CORPORATION

Amendments made: No. 20, in page 1, line 20, at end insert—
'(3A) Shares issued to the Secretary of State in connection with the vesting of property, rights and liabilities in the successor company by virtue of subsection (1) above shall be issued as fully paid and treated for the purposes of the Companies Act 1985 as if they had been fully paid up by virtue of the payment to the successor company of their nominal value in cash.'.

No. 21, in line 21, at end insert—
`not later than the day on which an order is made under subsection (1) above,'

No. 22, in line 24, at end insert—
'(4A) Nothing in subsection (4) above shall be construed as limiting the operation of section 14 of the Interpretation Act 1978 (implied power to amend) so far as that section relates to the revocation of an order under subsection (4) above.
(4B) The Secretary of State may by order made by statutory instrument provide that provisions of the memorandum or articles of association of the successor company which have been specified in an order under subsection (4) above shall be alterable without his approval.'.—[Mr. Newton.]

Clause 2

POWERS OF SECRETARY OF STATE

Amendments made: No. 24, in page 2, line 14, leave out from 'State' to first 'the' in line 16 and insert
`may by regulations made by statutory instrument with the consent of the Treasury make provision—
(a) for guaranteeing'.

No. 25, in line 22, leave out 'to indemnify' and insert 'for indemnifying'.
No. 26, in line 26, at end insert—
'(3) A statutory instrument containing regulations under this section shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.

No. 27, in line 26, at end insert—
'(4) Any power conferred on the Secretary of State by the articles of association of the successor company shall be exercisable in the national interest notwithstanding any rule of law and the provisions of any enactment.'.—[Mr. Newton.]

Clause 3

CORPORATION'S POWERS PENDING DISSOLUTION

Amendments made: No. 28, in page 2, line 30, leave out paragraph (a) and insert—
'(a) for valuable consideration to assign the benefit of a contract for a loan or to extinguish, or vary, by agreement an obligation under a contract for a loan;'

No. 29, in line 46, leave out from 'may' to end of line 47 and insert
'by direction—
(a) prohibit the making by the Corporation after a date specified in the direction of offers to lend money;
(b) prohibit the making of loans by the Corporation after a date so specified; and
(c) make any prohibition contained in a direction under this subsection subject to such exceptions as may be specified in it.'.—[Mr. Newton.]

Clause 4

EXTENSION OF POWERS OF SECRETARY OF STATE

Mrs. Currie: I beg to move amendment No. 15, page 3,line 12, at end insert—
'(dd) to provide instruction for any person;'.

Mr. Deputy Speaker (Sir Paul Dean): With this we will take Government amendment No. 19.

Mrs. Currie: Amendments Nos. 15 and 19 are necessary to ensure that the National Health Service Training Authority is covered by the provisions of subsection (1) of the clause. The original drafting of clause 4 inadvertently created a situation where the NHSTA would have been able to recover only the full costs of services to non-NHS customers and not to make a profit. That is because the NHSTA's powers to charge for training come from different legislation—the Health Services and Public Health Act 1968. If we do not make the specific amendments that are before us today, the NHSTA will not be able to charge outside customers at commercial rates. The amendment merely brings the NHSTA into line with other health authorities. It does not permit the NHSTA to impose any sort of charge on health authorities.

Amendment agreed to.

Mr. Hinchliffe: I beg to move amendment No. 2, in page 3, leave out lines 21 to 28.

Mr. Deputy Speaker: With this, we will take the following amendments: No.45, in page 3, line 31, at end insert⤔
'( ) The directions may not apply to any action taken or commenced by the body so directed before the day following that on which the direction is given.'.

No. 46, in page 3, line 31, at end insert—
'( ) The directions may not be given to Community Health Councils nor to Local Health Councils.'.

No. 47, in page 3, line 37, after 'satisfied,' insert—
'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service".

No. 49, in page 3, line 41, at end insert—
(b) will not be to any significant extent prejudicial, directly or indirectly, to the health of any person or group of persons;'.

No. 50, in page 3, line 48, at end insert—
'(6) In exercising the powers conferred by subsection (1) above, the Secretary of State shall have regard to the value of management time likely to be used in any proposal under consideration, and to the viability of the proposal under


normal commercial circumstances having regard to the rate of return of the capital value of assets employed in whole or in part to the proposal'.

No. 51, in page 4, line 5, after 'determine', insert
'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

No. 52, in page 4, line 6, after 'determine', insert
'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

No. 54, in page 4, line 12, after 'satisfied', insert
'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

No. 55, in page 4, line 43, after 'satisfied', insert
'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

Mr. Hinchliffe: The amendment seeks to negate the very wide-ranging powers to be given to the Secretary of State under the various provisions of clause 4. It is a matter of some concern to Opposition Members that the Health and Medicines Bill has been generally presented as containing a series of reforming measures, designed to improve health care provision, and a number of largely unrelated provisions and proposals geared to making the National Health Service more efficient and effective. In reality, the Bill has a consistent and worrying theme—the further advancement of the market forces approach to health care.
While most attention has been given to clauses 8 and 10 of the Bill, particularly because of the threatened rebellion of Tory Members tomorrow—we will wait and see what happens then—by far the most serious implications for the future of the National Health Service are contained in clause 4. It is very sad that we should be discussing an issue as serious as this in the early hours of the morning, with so few hon. Members present.
The stated aim of clause 4 is to devolve fund-raising powers to district health authorities. The aim of the Government is clear. We discussed it in some detail in Committee. What they want to do with this particular clause is to get themselves off the hook as regards the under-funding of the National Health Service. I recall that the most recent report of the all-party Select Committee indicated that the current cumulative under-funding is in the region of £2 billion—a shocking indictment of present Government policy. So they want to get off the hook of their failure to invest in the health care of this country.
Clause 4 is a deliberate attempt to divert attention away from the Government's responsibility to fund the National Health Service because, if the clause goes through, district health authorities can be blamed for failing to tackle under-funding at local level through the powers that they will have if the Bill passes into law.
I already find that whenever I write to the Minister about Health Service issues she blames the local district health authority, no matter what subject I mention. I am primarily writing to her about under-funding and the lack of resources, and she puts the ball squarely in the court of the district health authority. I do not think that that is fair, but she will have an even greater opportunity to do that if this clause is passed.
The second aim of the Government in this clause is to gear district health authorities and area health boards to being more concerned with profit-making ventures than with provision for patient care. That worries me very much.
1 am
To be fully understood, clause 4 needs to be considered in the context of several developments. I shall specify two to which some consideration should be given. The first is the introduction into the Health Service in the last couple of years of business-style general management since the Griffiths report on management structure and, in many areas, the arrival into the Health Service of personnel who have been brought directly from private business operations.
The second issue, which ties in with that and is worrying when one considers what could happen as a result of clause 4, is the introduction of performance-related pay, which will give financial incentives on the implementation of clause 4. When I ask the Minister how many general managers in my area have received incentive payments, it worries me that I am told that that is confidential. People in many areas are worried that those incentive payments are paid to managers for closing hospitals and wards and discharging patients who should not be discharged.
I was grateful that my hon. Friend the Member for Cumbernauld and Kilsyth (Mr. Hogg) raised earlier the issue of cook-chill because, as the Minister is aware, I have pursued that matter with some vigour since last summer because of concern about it in my area. I am sorry that the Minister for Health has left the Chamber because he now professes to be an expert on the issue, but I hope that he will read my brief comments on it. One reason why I feel so strongly about the provisions of clause 4 is that in Wakefield we have had a foretaste of the kind of situation to which I believe clause 4 will lead.
The Minister will be aware that one of the first ideas that the new Griffiths-style general manager in Wakefield introduced when he was appointed a couple of years ago—a gentleman by the name of Brian Birchall who, I understand, used to work for United Biscuits Ltd.—was that of generating income and saving money through sacking catering staff and adopting a cook-chill system. Now, nearly three years later, it is interesting to see what has happened. A newly built £1 million kitchen has been standing empty, doing absolutely nothing, for over a year because of concern about the safety of that system, which has been condemned as unsafe by the district health authority's own microbiologist.
The DHA is currently having to divert money from patient care to pay for the new system. The most recent example—I hope that the Minister is listening to this because I want a response on this point later in the debate—is that Wakefield district health authority has been directed by the regional health authority to spend its additional allocation of £230,000 on making its cook-chill system safe. That money, which was begrudgingly allocated by the Government way back in November or early December, had been earmarked for the purchase of vital surgical equipment and for urgent roof repairs at Fieldhead hospital, which was designed by a gentleman who, I am sure, would be a supporter of the Government's philosophy. His name was John Poulson. That hospital roof is collapsing and needs repairing urgently. However, money is being diverted from those urgent repairs by the RHA to deal with the cook-chill problem.
The Government have turned down the authority's demand for an inquiry into that issue. I have a good idea why. Clearly, it would expose the nature of the policies that are being pursued by the Government on privatisation and the proposals contained in clause 4. Frankly, the


position in Wakefield is a shambles and a complete farce. It is precisely the position that we can anticipate when men of enterprise, who are now in general management, get their hands on the provisions in clause 4.
It is vital that the hidden agenda of clause 4 is fully understood, because it evidences the clear aims underlying the Government's policies. It is about establishing the framework for moving substantial parts of current National Health Service provision into the private sector. There is no doubt that the powers contained in the clause will allow that. That is what they are designed to do. It is about deliberately boosting private care within the National Health Service and privatising yet more essential services, with the obvious consequences for standards of service and employment conditions which we discussed earlier. It is about creating the right climate for the wholesale introduction of the private health care market. If the Government were honest, they would admit that that was their real agenda.
Amendment No. 2 seeks to delete dictatorial powers which the Government are taking on themselves to deliver what we regard as the real aims of the clause.

Mr. Fearn: Amendment No. 45 seeks to prevent the Secretary of State making retrospective directions. It would be most unfair to health authorities and their managers if retrospective directions were made. I am sure that this is not the Minister's current intention—at least, I hope it is not—but we all know what happens as events develop. Eventually conditions will arise in which a future Minister may be tempted to make a retrospective direction. I am endeavouring to take that temptation away from him or her.
Amendment No. 46 removes the right to give directions to community health councils and to local health councils. It is of the essence of these bodies that they are independent and free to represent the public in their districts.
At present the only sphere in which anyone can issue directions to CHCs is in respect of their spending only the sums allocated to them. The effect of putting CHCs under potential ministerial control as regards the priorities for activities would be to detract from that independence. I am as sure as one can reasonably be that the Government have no intention of ever issuing directions to CHCs and LHCs. I believe that the fact that the bodies were covered by clause 3 did not occur to the draftsmen. I invite the Government in all seriousness to accept the amendment.
The five amendments in this set provide for the Secretary of State to consult such bodies as appear to him to represent the interests of the public within the Health Service before he takes action. Community health councils have this responsibility for the public in their districts, and national and local politics both have local effects. Of course, the National Association of Community Health Councils and the Scottish association would be available as channels for consultation, and the Secretary of State may have other bodies in mind. Consultation would give a local input where the Secretary of State is making a detailed intervention in local services. Amendment No. 47 requires him to consult before saying that he is satisfied that there will be no adverse effects from his proposals.
The clause as drafted says that the Secretary of State may not fail in carrying out a duty laid upon him by the National Health Service Act 1977. Amendment No. 49 writes in the other side of the same coin. Under it he would

be proscribed from doing anything that had adverse side effects for the health of the community. Health promotion and the prevention of ill health are important. It is essential that the search for money should not finish up damaging the health of individuals and, incidentally, increasing the workload of the NHS.
Amendment No. 50 seeks to impose on the Secretary of State the same criteria of commercial viability as the Government impose on local government direct labour organisations. It would be wrong if subsidiary activity—which fund-raising must be in NHS terms—ate up a significant amount of management time and NHS resources. The function of the NHS is to improve the health of the population. All else is subsidiary If the Government are unwilling to abide by the same constraints as they apply to local government, we have the right to ask why.
The amendments do not set out to reverse the principle of the Government's proposals, which will inevitably go through. We seek to ensure that the proposals do not detract from mainstream health services and that they operate in a civilised manner. It is to be hoped that the Government will accept these minor amendments.

Mr. Galbraith: My remarks will be brief, because the Minister will go to the Dispatch Box replete with quotations from my good self about support for clause 4.
I support the methods by which the NHS can recoup funds that have been spent on its behalf through the intervention and behaviour of people and companies. In other words, the NHS is losing money that rightfully belongs to it. It is certainly time that the NHS was able to recoup that money. The Minister will remember that I suggested several methods by which the NHS might be able to recoup some money. Perhaps amendment No. 86, which deals with overseas patients, might have taken that point on board.
Despite liking some parts of the clause, I find it difficult to accept it, for two reasons. One is the point that was raised about health boards being instructed and not being given options. The other reason was raised by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). Throughout the debate about the under-funding of the NHS, we have heard that, somehow, all problems will be solved by income generation. That is not the case. They are minimal amounts of money. Next year the figure will be about £10 million. and in the best possible year about £70 million. That is unacceptable, bearing in mind the inherent dangers in the clause. Therefore, it is worth making the position clear before the Minister reads out my quotations.

Mr. Corbyn: I shall not detain the House for too long, as some hon. Members probably wish to go home. We are dealing with the heart of the Bill and the most serious part of it. It is based on the false notion that the solution to the Health Service's financial problems is simply to turn each local health authority into some kind of income generation unit—that is, a local company—and start charging and recharging between various hospital departments and, indeed, within health authorities. Frankly, the whole matter is complete nonsense.
The Health Service exists to provide a health service for the people of this country. A district health authority exists to ensure the best possible provision of health care within its community. Income generation is not the business of a health authority. It is not competent to do it. It should not


be asked to do it. It has nothing to do with it. Yet health authorities are being told that they must examine the commercial potential of everything that they do. They must examine the commercial potential of each piece of land that they own and each facility that has been built on it, state whether it was given by charity in the past or built more recently, and consider ways of income generation from such nonsense as advertising on nurses' uniforms to opening shops within hospitals, and so on. It is complete and utter nonsense. I hope that the House will at least look carefully at the amendments, which will minimise the kind of nonsense that is proposed.
Essentially, the Bill is quite clever. It claims to promote a form of local decision-making, autonomy and democracy by allowing a local health authority to make charges, to commercialise, to sell, to buy, to trade, or whatever else, but, at the same time, by a convenient sleight of hand, it effectively moves what remaining powers district health authorities have straight into the Minister's hands. In effect, the Minister can direct certain forms of sale or charging merely by withholding central grant from local health authorities.
First, I hope that the House will accept that the Minister's power of direction is wholly wrong. Secondly, the effect of the proposals within the clause will not be an improvement of local health care, but will be the appointment of a whole new generation of business managers and the establishment of a business advice centre within the DHSS. It will effectively make local health authorities commercial organisations that are more interested in balancing their books than in improving health care and examining the health problems of people in their communities and cause them to move away for ever from the real purpose of the service.
Rather than this nonsense about book-keeping exercises in local health authorities, we should be discussing the way in which central Government have consistently denied local health authorities sufficient funds to deal with the problems that they face and have sought to abuse them when they have criticised the Government for giving them insufficient funds. We should be talking about shifting power in the direction of some form of democracy in the Health Service rather than destroying it, as the Minister intends to do.
1.15 am
I hope that the House will consider the proposals and that the Minister will think again and realise that charging is not the solution to the financial problems of local health authorities. The only solution to those problems is a very large injection of central Government money into local health authorities rather than handing that money out in tax relief to those in our society who already have a great deal of wealth, which is no doubt the option that the Minister prefers.

Mrs. Currie: As hon. Members will know, in very general terms, clause 4 is directed at giving health authorities more freedom to raise income for the good of the National Health Service. Indeed, the opening words of the clause are:
in order to make more income available for improving the health service".
I should have thought, therefore, that the clause would be widely welcomed. We were a little surprised and

disappointed that the reception to it has been less than enthusiastic in one or two quarters. However, I am grateful to the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) for what he has said. I shall desist from embarrassing him further, except to point out that he said in Committee that the clause had some good parts to it. From him, that is not damning with faint praise; it is an enthusiastic response, and we are grateful to him for it.
I listened with care to the hon. Member for Wakefield (Mr. Hinchliffe). He said that clause 4 is the most important part of the Bill. The Government think that it is very important, although the hon. Gentleman's hon. Friends clearly do not agree with him, as most of them appear to have gone home. The hon. Gentleman thinks that the clause is awful. We do not agree with that, and nor does NUPE. NUPE thinks that clause 4 is not bad at all. I wonder whether in his busy week the hon. Gentleman managed to come to terms with NUPE's submission to the Select Committee on Social Services, reported in The Guardian on 5 April this year. NUPE supports some ideas for income generation and says:
It would add considerably to the attractiveness of hospitals if shops and banks were on the premises. There are also advantages in health authorities marketing some of the services they provide (eg laundry, catering) to other public bodies and the private sector.
That is NUPE's point of view. I am not sure how seriously I should take what NUPE says because later it says that the main cause of illness in this country is malnutrition, which is perhaps something that we should refer to the hon. Member for Kirkcaldy (Dr. Moonie).
It is interesting to see how attitudes have shifted. In Committee I said that I could hear the sound of a troglodyte moving on this matter. When clause 4 first appeared, the Opposition parties jumped up and down and objected. When they read it and thought about it, however, they gradually realised that raising money for the Health Service, as provided for by the clause, is a good idea and very sensible.
The hon. Member for Wakefield talked a lot about cook-chill. I cannot quite see what the catering system that they use in Wakefield has to do with income generation. The system to which the hon. Gentleman refers is not generating income; it has cost a lot of money. What we expect to have it generate fairly soon are some decent meals for the people who have paid for it through their taxes.

Mr. Hinchliffe: I mentioned cook-chill in the context of clause 4 because that system was introduced by the new general manager as a means specifically of saving money but also of generating income—just as the Minister suggests clause 4 will generate income to local district health authorities. I used cook-chill as an illustration of what can go wrong under clause 4.

Mrs. Currie: We do not expect 100 per cent. success with all the things that we get up to in the largest business in western Europe, and I am sure that the hon. Gentleman has accurately described what will happen in the future in Wakefield. Surely any measure that helps us to increase the resources available for health care is welcome. We estimate that the income generation initiative will raise about £20 million a year at the beginning, rising to perhaps £70 million in three years. I say quite honestly to the House that I hope that our estimates are wrong and that health


authorities will raise much more than that. The money raised will help us to provide better patient services. This is National Health Service money and it will stay in the National Health Service to go on buying patient services and patient care.

Mr. Corbyn: Will the Minister give her estimate of the cost of taking on new management staff in order to promote this income generation? Can she tell us specifically what work she has done and how much money has been spent on setting up the advice unit that the Minister said would be established in the DHSS to advise district health authorities on income generation schemes?

Mrs. Currie: The new income generation scheme is not yet costing us much money. The person we have appointed, Mr. Kerr, is working on it at the rate of one day a week. That is partly because his powers depend on the passage of the Bill. We have every expectation that not only will he earn his peanuts but that he will help us put a great deal of money into the Health Service. That also applies to all the other staff.

Mr. Galbraith: rose—

Mrs. Currie: Perhaps the hon. Gentleman would let me continue.
In Committee we dealt fairly with the notion that the clause will act in some way to the detriment of the NHS. I am sure that the House is aware that we spent eight sittings on this, which is probably more than the time that we spent on any other clause. I should like to make three general points. There is scope for health authorities to raise income in ways that are entirely sensible and reasonable. This will not lead to the NHS becoming a brash commercial organisation. We simply intend that authorities should be able to undertake relatively small-scale developments on a commercial basis for facilities that will satisfy a local need.
The typical large city centre hospital may have 250,000 visitors a year. They all stop to make a purchase before going to the hospital and will buy flowers or a card or chocolate. Why should the hospital not get that trade and make a profit? Let us go further. Why should the staff have to go outside? Many hospitals are much bigger than factories and employ more people. We will welcome banks, building societies, hairdressers, almost anything, provided it does not interfere with the running of the hospital. That is written into the clause.
As I said repeatedly in Committee, we want to look after the National Union of Public Employees. If NUPE wants to have a conference, we will be delighted to accommodate its members. They will be welcome and we shall charge them for the room and lay on a nice buffet. We shall charge for the buffet as well at highly competitive commercial rates. I shall be quite happy if the people who prepare the food are also members of NUPE.
Since the business of the Health Service is to provide a health service, I can well see money being made as our staff provide a much needed occupational health service on contract to local businesses, either on their premises or on ours. The possibilities are legion and very exciting.
The National Association of Health Authorities has just sent me a copy of its booklet "Income Generation in the National Health Service." That came out of a conference that the association organised in December, and it is quite clear that many of our ideas are already

being implemented or are about to be implemented. Shropshire health authority is proposing to have advertising on closed circuit television, and that will raise an estimated annual income of £100,000.
The Greater Glasgow health board is looking at advertising and planning to maximise advertising potential on stationery, hoardings and vans. Consultation is under way on the feasibility of setting up a consortium of health boards in Scotland for advertising purposes and that will bring in an estimated income of about £25,000. If that was done in my constituency, it would go down a lot better than "Derbyshire supports nuclear free zones", which is the advertising that we get on all our public sector stationery at the moment.
The catering services in Brighton health authority provide meals to outside organisations, including resettlement centres and Age Concern. It has been in operation for some time and brings in an estimated income of £20,000. South Bedfordshire health authority runs its printing department on a commercial basis and has an estimated annual income of £20,000. Portsmouth and South-East Hampshire health authority has a very good central sterile supplies department and provides a service to other health authorities and to private industry. According to the National Association of Healrth Authorities, the estimated annual income is £600,000. I do not know whether that is a misprint, but it gives an idea of the sort of income that might be possible. The possibilities are exciting and we look to Ron Kerr and his staff to help carry the proposals forward.
I turn to the amendments tabled by the hon. Member for Southport (Mr. Fearn). On amendment No. 46, to the extent that community health services and other such bodies can make use of the powers, we see no reason why they should not be subject to the same powers of direction as the health authorities. We understand that amendments Nos. 47, 51, 52, 54 and 55 seek to require the Secretary of State or, where powers are delegated, the health authority to consult bodies representing the public before embarking on any income generation scheme, before setting amenity bed charges, before authorising pay beds and before setting pay bed charges. I welcome this opportunity to repeat the assurances I gave in Committee that there are adequate safeguards contained in clause 4 to ensure that nothing may be done that might affect adversely the duties of the Secretary of State under the National Health Service Act 1977. We already consult widely on all sorts of major issues and the views of the community health councils are taken along with, for example, the views of private sector health care providers and NHS staff on the issue of pay beds.
In the case of relatively minor income generation activities such as the creation of a florist's shop or newsagent, it hardly seems necessary to write into law that the health authority must consult the local community health council.
Our concerns apply in much the same way to some of the other points. For example, amendment No. 49 talks about activities that may be injurious to health. We do not intend that authorities should introduce any schemes that run counter to general health policies. That will be set out clearly in the guidance that we will be issuing to the health authorities. In that guidance we will be suggesting, with reference to amendment No. 50, that health authorities should consider approaches involving the leasing and franchising of different activities. I understand the concern


expressed by the hon. Member for Wakefield, but I assure him that the amendments are unnecessary and should be rejected.

Ms. Harman: I will ask leave to withdraw the amendment, but I have to say that we will be watching the way in which the Government use—

Mr. Deputy Speaker: Order. This is a technical point. The hon. Lady may speak to the amendment, but it must be withdrawn, if it is to be withdrawn, by the hon. Member who moved it.

Ms. Harman: We are concerned to see how the Government will be using the new clause. It is clear that it will not free district health authorities to do whatever they want. The clause gives power to the Secretary of State to force district health authorities to do things that they do not necessarily want to do.
It is clear that from the central Exchequer there is a deliberate policy of under-funding district health authorities. That has been recognised by all independent reputable bodies, and it is disgraceful at a time when there is plenty of money available in the Exchequer that could be used to finance the Health Service. We are in no doubt, and neither are Health Service managers, that if any money is raised locally by district health authorities, it will simply be clawed back by a further reduction in allocation from the Treasury. That point was recognised by the right hon. Member for Brentford and Isleworth (Sir B. Hayhoe). It is also generally recognised that forcing managers at local level to generate income rather than health care and improved quality of services would be a diversion from the task that we should be setting them, which is to improve the quality of care.
I hope that the Minister will not seek to continue to misrepresent our view or that of NUPE. We are certainly not against the idea of shops and so on being used as an amenity for those people who work in, are treated by or who come to visit people in the Health Service. We are against the idea of the Health Service as a whole having to be financed from peanuts raised at local level when there is plenty of money in the Exchequer to enable it to be run properly.
Basically, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) stated, this is more of a thrust towards commercialisation of the Health Service. We do not want to see that, nor do the Health Service professionals, others who work in the Health Service, the British people, or the managers. We shall be watching with concern, if the Government refuse to amend the Bill in the way that we want, to see how they operate this clause.

Mr. Hinchliffe: Had we been discussing this matter earlier in the day, I would have pursued it to a Division. For the reasons given by my hon. Friend the Member for Peckham (Ms. Harman), I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Deputy Speaker: I understand that Government amendments Nos. 16, 17 and 18 are not to be moved.

Mr. Fearn: I beg to move amendment No. 53, in page 4,line 34, leave out from 'section' to 'hospitals' in line 38 and insert—
'unless he is satisfied that sufficient accommodation and facilities are available for services provided by the National Health Service'.

Mr. Deputy Speaker: With this it will be convenient to take amendment No. 56, in page 5, line 12, leave out from 'section' to 'hospitals' in line 16 and insert—
'unless he is satisfied that sufficient accommodation and facilities are available for services provided by the National Health Service'.

Mr. Fearn: These amendments reverse the intention of the Bill. The Bill says that the Secretary of State shall revoke provision for private practice only if he is sure that there is adequate provision elsewhere. We say that he should revoke that authority unless he is sure that there is enough National Health Service provision.
The duty of the Secretary of State is to manage the National Health Service and to provide a comprehensive public service. Private services are a matter for the market; they have nothing to do with the Secretary of State.
What does the Secretary of State propose if there is insufficient provision for the National Health Service and the private sector? Under the clause he is to protect the private sector and let the National Health Service go hang. That is entirely wrong because anybody in the population can use the National Health Service, but only people who can afford to do so can use private services.
There can be no justification for the Government's view. It is a direct attack on National Health Service provision in places where there are poor services. It is happening at a time when the National Health Service is increasingly falling short of meeting public need. This is an issue of principle. If the Secretary of State acts in accordance with the terms of the clause, he will be failing the National Health Service.

Mrs. Currie: The purpose of subsection (2) that is the subject of amendment No. 53 is simply to restate the powers that have been in place since the Health Service Act 1980. The Government have no intention to change the Secretary of State's powers to authorise or to revoke provision of pay beds. Amendment No. 56 covers the same ground for Scotland. I urge hon. Members to reject the amendments.

Amendment negatived.

Mrs. Currie: I beg to move amendment No. 86, in page 5,line 18, at end insert—
'(9) In section 121 of the National Health Service Act 1977 (charges in respect of non-residents) after the word "charges", in the first place where it occurs, there shall be inserted the words "as the Secretary of State may determine".
(10) In section 98 of the National Health Service (Scotland) Act 1978 (which makes corresponding provision for Scotland) for the words "may be prescribed", in the second place where they occur, there shall be substituted the words "the Secretary of State may determine".
(11) The following paragraph shall be added at the end of the sections mentioned in subsections (9) and (10) above—"The Secretary of State may calculate charges under this section on any basis that he considers to be the appropriate commercial basis.'''.
The amendment could be christened the "Galbraith amendment." I shall explain later exactly what I mean by that. I must apologise to the House for tabling the amendment so late this week. It deals with the setting of


charges in respect of National Health Service treatment of overseas visitors. At present, health authorities charge overseas visitors who are liable to pay for National Health Service treatment on the basis of the schedule of charges produced centrally. Those charges are largely derived from private patient charges. Since April 1987, health authorities have been able to set their private patient charges and clause 4 allows them to make commercial charges. We believe that it is sensible to bring the setting of charges to overseas visitors into line with private patients, and the amendment has that purpose.
We believe that there are good reasons for making that change. First, it will enable us to recover realistic charges from overseas visitors who are not coverd by inter-Government reciprocal arrangements or by other exemptions. From Royal Assent, the effect will be that overseas patients will be on the same footing as private patients. Secondly, it will be simpler because instead of having two sets of rules concerning overseas and private patients there will now be one, which will still be directed from the centre, although there will be a single set of rules and health authorities will set their rates according to the local market and their judgment thereon.
The hon. Member for Bearsden and Strathkelvin (Mr. Galbraith) convinced us of the value of tabling the amendment. He waxed eloquent about the subject on Second Reading and talked about it at length in Committee. I understand that there are restrictions on quoting an hon. Member, although I can quote a Minister's remarks, during the passage of a Bill. However, I refer hon. Members to a very long discussion that we had during the passage of the Bill. To recognise the conventions of the House, I shall not quote the hon. Gentleman exactly, but, broadly speaking, he said that often overseas patients are charged at a loss to the hospital.
People with considerable financial resources come to this country for highly specialised treatments that are available only in certain hospitals in certain countries. The hon. Member felt that there was no reason why hospitals should not charge non-residential patients at commercial rates. He said that it was not a major issue and he did not want to make a great deal of it, but he wondered whether the Minister would comment.The Minister is commenting. We checked the law, and the law as it stands would not allow us to do what he wanted, and that is why we tabled the amendment.
Many overseas visitors are exempt from NHS charges for various reasons—if they are European Community citizens, if they are covered by the reciprocal arrangements that we have with a number of countries, or if they are studying here. However, we agree with the hon.Gentleman that it is reasonable to expect the rest to be covered by travel and medical insurance, just as the British traveller abroad needs to be covered. It is entirely viable that, for those who have to pay, charges should be made on the same basis as those for private patients. Therefore, I urge hon. Members on both sides of the House to accept the amendment.

Amendment agreed to.

Mr. Deputy Speaker (Sir Paul Dean): Amendment No. 57.

Mr. Fearn: On a point of order, Mr. Deputy Speaker. I understood that we would adjourn on clause 4. Amendment No. 57 is part of clause 5.

Mr. Deputy Speaker: No such motion has been moved. Does the hon. Member wish to move his amendment?.

Mr. Fearn: Yes.

Clause 5

RETIREMENT OF PRACTITIONERS

Amendment No. 57 proposed, in page 5, line 40, after 'determine', insert

'(being no greater than the value of such loss)'.—[Mr. Fearn.]

Question, That the amendment be made, put and negatived.

Further consideration of the Bill adjourned—[Mr. Ryder.]

Bill, as amended (in the Standing Committee), to be further considered this day.

LOCAL GOVERNMENT FINANCE BILL (ALLOCATION OF TIME)

Ordered,

That the Order of 22nd February be varied by substituting for paragraph 2(1) the following:
'Report and Third Reading

2.—(1) The proceedings on Consideration and Third Reading of the Bill shall be completed in five allotted days and shall be brought to a conclusion at Ten p.m. on the last of those days; and for the purposes of Standing Order No. 80 (Business Committee) this Order shall be taken to allot to the proceedings on Consideration such part of those days as the Resolution of the Business Committee may determine:—[Mr. Howard.]

Elderly Persons (Maintenance Grants)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Ryder.]

Sir Anthony Meyer: I am very grateful to my hon. Friend the Under-Secretary of State for coming to the House at this late hour to answer the debate. I hope that the people of Wales will take note of how assiduously he carries out his duties even in the very small hours of the morning.
I should make it quite plain that I am concerned only with one specific point and not with the much wider question of the impact on pensioners and others of the changes in the social security system resulting not just from the Social Security Act 1986 but from many other factors, such as the increases in water charges and electricity tariffs, the requirement that all except the very poorest should pay 20 per cent. of their rates and the loss in many cases of rate rebates and lower interest rates for their savings, which is a very heavy factor for other people, but not so much for pensioners. Those factors, which affect the standard of living of many of the poorer pensioners, though not the very poorest, led me to abstain in the vote yesterday afternoon.
My abstention was intended as a criticism not of the DHSS or of my hon. Friend and his handling of these matters at the Welsh Office, but of the way in which they have been forced by the Treasury to make choices which they should not be forced to make in the country's present affluent circumstances. What is more relevant to the particular point that I am making tonight is that they are being driven into an approach which penalises even modest thrift, as part of the process of targeting benefit to the most needy.
I know that that problem crops up over all areas of social security. It is inseparable from any attempt to target help on those who need it most, though I think Ministers, and especially the Prime Minister, would do well to face it a bit more frankly and to admit that targeting benefits inevitably means damaging the people and discouraging the instincts that ought to matter most to a Conservative Government. I have to admit that the problem is one that has baffled Governments throughout the ages when they have set out to relieve poverty or distress.
The specific point that concerns me is the support for elderly people who are discharged from NHS hospitals into private nursing homes. As long as they are in hospital they are accommodated and treated free of charge, apart from an abatement of their pension after eight weeks, which no one will complain about. That is regardless of their means or the means of their spouse. But if that elderly person is discharged from a National Health Service hospital into a nursing home other than one run by the local authority, very different considerations apply. The fairly hefty fees must be paid, and in practice—certainly in my own county of Clwyd and, I suspect, in most other health authority areas—they are paid by the elderly person himself or herself, or by the spouse, if either have savings above the £3,000 level that disqualifies them from income support.
Let me put the case of one of my constituents who prefers not to be named. I shall call her Mrs. X. She is in her seventies and suffers from Parkinson's disease. Her husband is suffering from senile dementia and is being very

well looked after in a private nursing home. Her savings exceed the £3,000 limit, so the only help she gets is the attendance allowance, plus her husband's state retirement pension. All this goes towards meeting the nursing home fees. To pay the balance of £110 per week she has to draw on her savings. Last year she spent over £5,500 in this way. At this rate she will soon have no savings left, and only then will she be able to get the fees paid.
One solution is for elderly people to remain in NHS hospitals until they die and for their spouses to refuse point blank to pay any fees for them in nursing homes if they are moved out of hospital. That is what another of my constituents has been driven to do. He is 78 and has looked after his sick wife as best he could for many years, but he is now too infirm himself to go on doing so. His wife was admitted to hospital with fluid on the lung, and while there she first had a heart attack and then broke her femur. Now she is fit enough to be moved from hospital to a nursing home, but the husband wants to know who is to pay the fees. If he uses his remaining savings to do so, she may live a few years but he will be reduced to dependency on the state for the rest of his life.
I might mention another way in which the regulations are hurting people who move out of hospital into nursing homes. The hon. Member for Gower (Mr. Wardell) has been much concerned by this, and I am indebted to him for this example. I have other similar though less clear-cut cases in my own constituency. It concerns an 88-year-old lady who owns her own home and has been in a nursing home since 1985. On 1 April she was informed that she was no longer eligible for income support, presumably because the house she owns, though it yields no income, is a capital asset, valued above £3,000. She is trying to sell the house but she cannot do so. In the meantime, there is no money to pay the nursing home fees of £180 per week. The obvious answer in this case should be a bank loan, but it seems that bank managers are not sympathetic towards cases such as this, and under the new regulations the DHSS seems to have no discretion to help. So what is the poor woman to do?
It may be that my hon. Friend the Minister will quote to me from Health Circular 81(1) and tell me that where a consultant or a general practitioner recommends the transfer of a patient from an NHS hospital to a nursing home the health authority has the power to enter into contractual arrangements with the nursing home to care for that patient, at no cost to the patient or his or her spouse. But the health authority does not have to exercise that power, and certainly at Clwyd it has chosen not to do so. With the other pressures on it, and given the age profile of its area, I can see very clearly why it has so decided.
The solution suggested to me by my constituent Mr. Alun Roberts, to whom I am indebted for much of my information, is that funds should be allocated to health authorities for specific purposes such as this. I am not so sure about that. I can easily envisage other problems which would require specific funds to be dedicated to them, and there could be no end to such piecemeal financing.
None the less, the Government should surely be seeking some way not just of mitigating the very damaging effects that their targeting polices are having on people's instincts for thrift, but£more specific to my purpose tonight£of making it easier instead of harder for elderly people to move out of hospitals and into nursing homes. Even if we consider the matter purely in terms of value for money, it must make sense to encourage people to move out of


hospital, where they are very costly to look after, to nursing homes, where they can be looked after at substantially lower cost.
It seems absurd to do anything to discourage that. By withholding financial support from public funds and making what may in the end prove to be a vain attempt to force spouses to spend their small savings to pay the fees, we may well end up by placing a greater burden on public funds. Moreover, we shall have added substantially to the heavy burdens already being borne by the relatives of elderly sick patients.

The Parliamentary Under-Secretary of State for Wales (Mr. Ian Grist): I congratulate my hon. Friend the Member for Clwyd, North-West (Sir A. Meyer) on his success in obtaining this Adjournment debate. His compassion and concern for the more vulnerable members of society—and particularly for his constituents—is always apparent. I am particularly grateful to him for raising this important subject, because it is one that concerns us all and one to which the Government have given considerable and detailed attention.
My hon. Friend has given the House examples of the needs of individuals which raise important general principles. If my response seems concerned primarily with principles and with general rules, that is in no sense because that is how the Government perceive the issues. However, soundly based principles are the essential bedrock of a system of support that best meets the needs of individuals as individuals.
Let me start with one of the most important of those principles—one to which my hon. Friend has rightly referred. It is that there is no question of our departing from the fundamental principle that access to medical care should not depend on the ability of an individual to pay. Let me be specific about this. Our position is clear and on the record in all our public statements, and in our advice to the health authorities: no patient who comes to the NHS should be placed in a private nursing home against his or her wishes if that person, or a relative, would be responsible for the home's charges.
I know that my hon. Friend chooses his words carefully, and I did not hear in what he said any suggestion imputing any undue influence, direct or indirect, on the individuals, the details of whose circumstances he draws to the House's attention, or any suggestion that they or their relatives had been persuaded against their better judgment to agree to placement in a private home. If, however, my hon. Friend has any such evidence I should very much like to have it so that I can take the matter up with the relevant authority and receive a full explanation.
That would be a serious matter. I stress this not least because not only are the consent of the individual and the views of affected relatives to be respected, but decisions about the discharge of people from hospital are for the medical consultant in charge of the patient's care to make—and they must be made on clinical grounds. Financial considerations, therefore, should not enter into the consultant's decision. Thus, when a consultant decides that a patient requires continuing medical or nursing care as an in-patient, it falls squarely and unequivocally on the NHS to supply it, at no cost to the patient or his or her relatives.
The care needed may be provided either directly by the NHS in an NHS bed, or by transfer to a private nursing

home under contractual arrangements under which the NHS—not the patient—meets the full costs and retains the ultimate responsibility for the patient's care.
I should like to stress that the status of patients in such contractual facilities is thoroughly safeguarded and protected. Let me quote from the circular referred to by my hon. Friend:
A patient admitted to or using a contractual facility remains an NHS patient and may only be charged for services as permitted by the NHS Acts. The arrangements for the use of independent facilities should provide for treatment and maintenance with the usual amenities without charge to the patient in exactly the same way as a patient in an NHS establishment. Authorities should be careful to ensure that patients are not pressed into paying for extra amenities (outside the terms of the contract) which they do not want. There should be no disparity between the clinical care and services provided to NHS patients and the hospital or home's private patients.
When someone in hospital no longer needs the level of medical or nursing care provided, it is open to the hospital to arrange a more suitable placement. When patients are moved from an NHS hospital to a nursing home, the health authority should make it clear whether or not it will pay for the patient's care before he is transferred; and, as I have already said, no patient can be transferred without his consent if he or a relative has to be responsible for the home's charges.
I hope that I have established clearly the approach that the Government have taken, and continue to take, on the protection of the rights of the individual. Clearly, the fulfilment of the objective of meeting the needs of individuals for medical and nursing care is a major and continuing challenge for our health authorities. They must meet it by making maximum use of their own community health staffs and by working in collaboration with social service authorities and others with a part to play in enabling people to live in their own homes whenever possible, where that matches their wishes.
That increasing throughput, and the keeping of hospital episodes to a minimum, must be seen as part of our overall strategy for the elderly in Wales. That has been aimed—through effective collaboration with all the agencies involved—at trying to maximise people's potential to remain living independently and to keep to a minimum any spells of inpatient care that may be needed.
Last year we launched our elderly initiative. under which we are making available some £7 million to fund pilot, innovative and, it is to be hoped, replicable projects in the provision of care for elderly people.
I turn now to the second important set of issues that my hon. Friend raised when he appeared to suggest, by referring to particular cases among his constituents, that it is in principle unfair that a person who decides he wishes to be cared for in a private nursing home on a permanent basis should be required to contribute towards the costs of that care. I should be surprised if that is what my hon. Friend intended to imply, and it may be that I have not fully understood him.
The Government's view is clear. Where people genuinely cannot afford the care they need, but where they elect to have that care in a private nursing home, income support will be payable to them up to the relevant limit. Incidentally, we have recently increased the limits significantly. For instance, in nursing homes for the elderly, the limit has been raised a further £10 to £185. That means the limit for those homes will have increased by £50 in three years.
Government spending on support for people in private and voluntary homes has risen from £10 million in 1979 to some £0·5 billion now, but the Government believe it is right that the individual should look to his or her resources before drawing on public funds. I hope that my hon. Friend can see the sense in that. Any other arrangement would not only be grossly unfair to the taxpayer, but would make it impossible to concentrate assistance on those who need it most. It must be remembered that we are talking about people who should themselves have decided that they wished to be cared for in a private nursing home.
Once the principle is accepted that it is right to have regard to an individual's own resources before deciding what public resources might be paid, difficult, sensitive and complex questions arise as to the circumstances in which individuals should receive support—and to what extent. So we have developed a number of important safeguards that are relevant to the issues and examples my hon. Friend has raised.
First, where one of a couple is permanently resident in a nursing or residential home, their entitlement to income support is assessed—as was their entitlement to supplementary benefit—separately. So if the spouse in residential care has no savings, but the partner who is not in residential care has, that will not affect the entitlement to benefit of the spouse in residential care.
Moreover, where there are joint assets, for the purpose of assessing entitlement to benefit they must be divided equally between the two individuals. Perhaps most important of all, where the partner of someone who has entered residential care permanently, or another elderly or incapacitated relative is still living in the family home, the value of the house is disregarded in the assessment of entitlement to benefit of the person in residential care.
I should say also that the cases referred to by my hon. Friend arose before this week's social security changes came into effect, and no doubt he will welcome the fact that the capital exemption limit has been doubled to £6,000. That means that a substantial number of people have become eligible for benefit who were not previously eligible.
In those ways, and with those safeguards, the Government have sought to strike the right balance between helping those in real need who genuinely cannot be expected to help themselves, or help themselves fully, and our duty as stewards of public resources paid for by the taxpayer.
Let me repeat my invitation to my hon. Friend to pass on any details of cases that he has mentioned, including the case of the lady who has a problem in selling her house, where individuals do not appear to have been treated in accordance with the arrangements that we have laid down. However, I must ask him to draw those matters to the attention of my right hon. Friends at the Department of Health and Social Security. More directly, he might like to suggest to his constituents, or to the local DHSS officials, where appropriate, that a fresh assessment of the entitlement of individuals should be carried out.
I began by saying that the issues which we have been able to debate at this late hour are fundamental and important. They concern, as I have said, some of our most vulnerable citizens. As I am sure my hon. Friend is aware, the number of very elderly people in Wales—those aged over 75 in particular—is set to continue to rise dramatically in the years ahead, from an estimated 189,000 in 1986 to more than 220,000 by the year 2001—a mere 13 years away. Their needs for care will be one of the principal issues facing us as a society.
That is just one of the reasons why we are reviewing with the greatest care the future arrangements for the public financing of community care in the light of Sir Roy Griffiths' recent report. To pick up what my hon. Friend has referred to, Sir Roy has not said what level of financial support should be provided by the Government towards community care. What he has done is to produce proposals aimed at securing the better organisation and delivery of care for individuals, whatever the level of public funding.
We are considering that report and we will come forward with our own proposals as soon as possible. I shall certainly bear in mind all that my hon. Friend has said as we do this and as we review how we should meet this great human challenge.

Question put and agreed to.

Adjourned accordingly at three minutes to Two o'clock.